tlifornia 

ional 

lity 


U.  S.  DEPARTMENT  OF  LABOR 
WORKING  CONDITIONS  SERVICE 

GRANT  HAMILTON,  Director  General 


PRELIMINARY  REPORT 

OF 

OMMITTEE  ON  MORTALITY 
FROM  TUBERCULOSIS  IN 
DUSTY  TRADES 


?N  BRANCH, 
ALI 

CALIF. 


WASHINGTON 

GOVERNMENT  PRINTING  OFFICE 
1919 


U.  S.  DEPARTMENT  OF  LABOR 
WORKING  CONDITIONS  SERVICE 

GRANT  HAMILTON,  Director  General 


PRELIMINARY  REPORT 

OF 

COMMITTEE  ON  MORTALITY 

FROM  TUBERCULOSIS  IN 

DUSTY  TRADES 


WASHINGTON 

GOVERNMENT  PRINTING  OFFICE 
1919 


INTRODUCTION. 


This  preliminary  report  of  the  Committee  of  the  National  Tuber- 
culosis Association  on  the  Mortality  in  Dusty  Trades  affords  students 
a  rare  opportunity  to  gain  a  real  insight  into  the  methods  of  the 
committee.  It  announces  the  formation  of  a  committee  and  its  pro- 
gram of  investigation  in  a  field  that  has  long  been  recognized  as  of 
primary  importance  in  industrial  hygiene.  The  immediate  investi- 
gations will  deal  with  trades  in  which  inorganic  dusts  have  been  found 
to  be  harmful  to  workers — the  marble  and  granite  industries  and 
work  in  quarries.  From  time  to  time  additional  reports  will  be  pub- 
lished giving  the  progress  of  the  committee's  work.  The  committee 
consists  of  the  following: 

Dr.  Frederick  L.  Hoffman,  chairman,  third  vice  president,  and 

statistician,  Prudential  Insurance  Co.,  Newark,  N.  J. 
Dr.  Edward  R.  Baldwin,  Trudeau  Sanatorium,  Saranac  Lake, 

N.  Y. 
Dr.  Alice  Hamilton,  expert,  Bureau  of  Labor  Statistics,  U.  S. 

Department  of  Labor,  Washington,  D.  C. 
Dr.  H.  R.  M.  Landis,  Henry  Phipps  Institute,  Lombard  and 

Seventh  Streets,  Philadelphia,  Pa. 
Dr.  A.  J.  Lanza,   chief,  Industrial  Hygiene  and  Medicine, 

Working  Conditions  Service,  U.  S.  Department  of  Labor, 

Washington,  D.  C. 

Dr.  O.  W.  McMichael,  Asheville,  N.  C. 
Dr.  Alfred  Stengel,  professor   of  medicine,   Medical   School, 

University  of  Pennsylvania,  Philadelphia,  Pa. 

The  report  is  published  by  the  Working  Conditions  Service  as  part 
of  its  work  of  giving  information  of  scientific  studies  made  to  better 
working  conditions.  The  work  of  the  committee  will  be  of  practical 
assistance  to  the  service. 

GRANT  HAMILTON, 

Director  General. 


SUMMARY  REPORT  OF  THE  COMMITTEE  ON  THE  MORTALITY  FROM 
TUBERCULOSIS  IN  DUSTY  TRADES  OF  THE  NATIONAL  TUBERCULOSIS 
ASSOCIATION. 

SUBMITTED  TO  THE  EXECUTIVE  COMMITTEE,  PITTSBURGH,  DECEMBER  5,  1918. 


The  following  rather  extended  report  has  been  arranged  in  a  sum- 
marized form  as  a  matter  of  convenience,  not  only  for  the  member- 
ship of  the  committee  but  also  for  the  information  of  the  executive 
committee  and  the  board  of  directors.  It  is  a  record  of  the  com- 
mittee's activity  and  the  meetings  held. 

The  Committee  on  Mortality  from  Tuberculosis  in  Dusty  Trades 
was  appointed  by  the  president  of  the  National  Tuberculosis  Asso- 
ciation, in  response  to  a  resolution  which  was  unanimously  adopted 
by  the  board  of  directors.  Under  date  of  December  21,  1917,  the 
following  letter  was  addressed  by  the  chairman  to  the  members  of 
the  committee,  outlining  briefly  the  proposed  plan  and  scope  of 
the  contemplated  investigation,  although  necessarily  in  a  rather 
tentative  form: 

It  affords  me  much  pleasure  to  acknowledge  your  acceptance  of  membership  on 
the  Committee  on  Tuberculosis  in  Dusty  Trades.  It  requires  no  argument  of  mine 
to  emphasize  to  you  the  practical  and  far-reaching  importance  of  more  qualified 
technical  consideration  of  this  heretofore  neglected  aspect  of  the  tuberculosis  problem 
in  this  country.  Your  cooperation  can  be  made  of  real  value  to  the  association  which 
has  extended  to  us  this  opportunity  to  give  the  matter  official  consideration.  I 
would  therefore  welcome  an  early  intimation  of  your  viewpoint  regarding  the  trades 
or  occupations  which  in  your  opinion  should  receive  prior  consideration.  It  has  been 
suggested  that  we  might  take  up  at  the  outset  the  question  of  tuberculosis  frequency 
in  the  stone  industry,  selecting  two  or  three  recognized  centers  of  its  most  important 
branches,  such  as  granite  cutting,  marble  cutting,  and  sandstone  cutting.  The  slate 
industry  in  eastern  Pennsylvania  would  seem  to  offer  a  very  promising  field.  From 
another  point  of  view  it  might  be  of  real  value  to  examine  into  the  facts  of  actual 
tuberculosis  frequency  in  the  cement  industry,  which  is  comparatively  free  from  the 
disease  if  the  available  statistical  data  and  the  special  research  work  of  Dr.  Tucker 
can  be  relied  upon.  From  much  the  same  point  of  view  a  tentative  inquiry  might 
be  made  into  the  occurrence  of  tuberculosis  among  coal  miners,  say  in  the  Scranton 
district,  of  which  original  investigations  were  undertaken  by  Wainwright  and  Nichols 
eome  years  ago.  Possibly  after  Dr.  White's  return  from  France  he  might  help  us 
with  laboratory  research  in  Pittsburgh,  with  special  reference  to  the  soft-coal  mines  of 
western  Pennsylvania.  The  investigations  which  have  been  made  by  the  Bureau  of 
Mines  and  the  United  States  Public  Health  Service  in  the  zinc  and  lead  mining 
districts  of  southwestern  Missouri  are  suggestive  of  further  study  and  analysis  of 
mortality  statistics  and  possibly  the  collective  records  of  practicing  physicians, 
hospitals,  etc. 

5 


6  MORTALITY  FROM  TUBERCULOSIS  IN  DUSTY  TRADES. 

In  the  case  of  each  and  every  one  of  these  specialized  studies  it  would  seem  neces- 
sary as  a  basic  consideration  that  a  thorough  analysis  should  be  made  of  the  deaths 
from  tuberculosis  and  respiratory  diseases  of  persons  aged  15  and  over  in  the  sections 
selected.  This,  of  course,  would  require  the  cooperation  of  the  local  or  State  boards 
of  health.  Such  experience  as  the  writer  has  had  is  suggestive  of  the  most  hearty 
cooperation  if  the  officials  in  charge  are  properly  approached. 

Aside  from  the  occupations  with  exposure  to  inorganic  dust,  it  would  seem  well 
at  the  outset  to  take  up  at  least  one  occupation  or  industry  with  exposure  to  organic 
dust.  Perhaps  the  most  important  of  these  is  the  cotton  industry,  and  a  comparative 
study  might  be  made  of  the  mortality  of  a  representative  mill  town  in  New  England 
and  the  South.  The  mortality  analysis  should  be  amplified  by  dust  sampling, 
observations  on  temperature  and  humidity,  and  an  individual  as  well  aa  collective 
expression  of  qualified  local  medical  opinion.  The  information  which  has  become 
available  with  reference  to  the  occurrence  of  tuberculosis  in  cotton  spinning  and 
weaving  in  this  country  as  well  as  abroad  suggests  a  much  more  thorough  and 
.  impartial  scientific  study  of  the  facts  than  has  been  made  thus  far. 

The  foregoing  observations  are  merely  tentative  and  an  indication  of  the  lines  of 
research  that  suggest  themselves  to  the  undersigned  as  practical  and  promising  of 
early  results.  It  may  be  interesting  in  this  connection  that  the  United  States  Bureau 
of  Labor  Statistics  expects  to  issue  during  the  early  part  of  1918  an  extensive  bulletin 
by  the  undersigned  on  the  mortality  from  respiratory  diseases  in  trades  with  exposure 
to  inorganic  dust,1  which  it  is  hoped  will  prove  of  substantial  value  in  the  further- 
ance of  the  research  herein  indicated  and  officially  approved  by  the  national  asso- 
ciation in  the  appointment  of  our  committee.  There  is  a  possibility  that  we  can 
interest  the  Census  Office  in  our  work  and  secure  much  valuable  technical  aid  and 
assistance  may  also  be  forthcoming  from  the  United  States  Public  Health  Service 
and  from  the  State  boards  of  health,  at  least  from  Pennsylvania  and  Massachusetts, 
and  possibly  the  Industrial  Commission  of  Ohio.  To  the  extent  that  such  cooperation 
is  secured  our  own  work  will,  of  course,  be  materially  reduced  in  important  matters 
of  detail. 

Preliminary  to  the  sending  out  of  this  letter  there  had  been  a 
fairly  extended  correspondence  with  Dr.  E.  R.  Baldwin,  of  the 
Edward  L.  Trudeau  Foundation,  with  particular  reference  to  a 
proposed  investigation  in  the  State  of  Vermont,  and  under  date  of 
November  7,  1917,  Dr.  Baldwin  wrote  to  Dr.  Hoffman  as  follows: 

In  view  of  the  favorable  attitude  of  the  Vermont  Marble  Co.'s  representative,  Mr. 
Frank  C.  Partridge,  and  Dr.  Caverly,  of  the  State  Board  of  Health,  the  investigation 
which  I  proposed  to  them  would  seem  to  be  quite  well  received.  I  therefore  am 
inclosing  a  preliminary  outline  of  the  kind  of  study  that  seems  to  me  worth  while 
for  your  criticism  and  suggestions.  I  hesitate  to  trespass  upon  your  time  for  this, 
but  knowing  your  interest  and  the  number  of  things  that  from  your  standpoint 
you  would  like  to  see  covered,  I  am  sure  you  can  be  of  great  assistance  in  sug- 
gesting further  inquiries  or  the  elimination  of  those  that  seem  hardly  worth  while. 
The  work  might  be  done  largely  at  the  Vermont  Sanatorium  at  Pittsford,  where 
Dr.  E.  J.  Rogers  is  resident  physician.  In  conversation  with  one  of  the  trustees 
(Dr.  James)  I  find  him  quite  favorable  toward  a  grant  from  the  Trudeau  Founda- 
tion for  this  purpose,  and  we  could  probably  furnish  an  assistant  under  the  fellow- 
ship plan  for  the  carrying  on  of  the  work  at  the  sanatorium  as  a  center.  The 
permission  of  the  granite  industry  would  have  to  be  obtained,  although  I  think  it 
could  be  secured  without  great  difficulty.  I  would  welcome  any  criticism  or  sugges- 
tion you  might  make  before  making  the  final  plan  for  this  work. 

i  Hoffman,  Frederick  L.:  Mortality  from  respiratory  diseases  in  dusty  trades  (organic  dusts).  Bull. 
231,  Bureau  of  Labor  Statistics,  U.  S.  Department  of  Labor.  Washington,  1918. 


MORTALITY  FROM  TUBERCULOSIS  IN  DUSTY  TRADES.  7 

This  letter  made  it  clear  that  Dr.  Baldwin  had  anticipated  the 
work  of  the  committee  by  taking  the  initial  steps  of  an  original 
investigation  which  had,  in  fact,  been  quite  fully  discussed  at  the 
meeting  of  the  board  of  directors  of  the  association  when  the  reso- 
lution for  the  appointment  of  the  committee  was  adopted.  The  plan 
proposed  by  Dr.  Baldwin  is  restated  in  its  entirety  below: 

INVESTIGATION   OP  THE   EFFECT  OF  THE   MARBLE   AND   GRANITE   INDUSTRIES  ON 

TUBERCULOSIS. 

HISTORY  AND  STATISTICAL  INQUIRY  FROM  THE  VERMONT  BOARD  OF  HEALTH  AND  THE 
UNITED  STATES  MORTALITY  TABLES. 

1.  Incidence  and  mortality  from  tuberculosis  among  workers: 

(a)  Dry  cutting. 
(6)  Moist  cutting. 

2.  Personal  inquiry  from  employees  in  industries,  with  family  histories: 

(a)  Dry  cutters. 
(6)  Wet  cutters. 

3.  House  to  house  census  by  medical  inspectors  of  present  and  past  illnesses  among 
families  of  cutters: 

(a)  Age. 
(6)  Race. 

(c)  Residences. 

(d)  Various  employments,  past  and  present,  of  tuberculous. 

(e)  Various  employments,  past  and  present,  of  nontuberculous,  especially  other 

chest  diseases. 

(f)  Duration  of  employment. 

(</)  Present  condition  of  employees: 

(1)  Apparently  well. 

(2)  Those  suffering  from  ailments,  especially  chest  or  throat  affections. 

MEDICAL  EXAMINATIONS. 

1.  All  who  show  symptoms  or  a  history  of  chest  disease: 

(a)  Chest  examination. 

(6)  Sputum  examination  (if  present). 

(c)  Families  of  those  who  have  tuberculosis. 

2.  Rontgenograms  of  all  who  have  chest  affections: 

(a)  Rontgenograms  of  25  dry  cutters  who  are  apparently  well. 
(6)  Rontgenograms  of  25  wet  cutters  who  are  apparently  well. 

3.  Calcium  determinations  in  urine  of  10  healthy  dry  cutters  in  marble  industry. 

(a)  Calcium  determinations  in  urine  of  10  healthy  wet  cutters  or  any  other 

nondusty  employment. 

(6)  Calcium  determinations  in  sputum  of  5  dry  cutters  who  have  bronchitis. 
Inspection  and  description  of  working  conditions. 

Determination  of  amount  (weight  and  bulk)  of  dust  in  terms  of  cubic  feet  of  air  in  dry 
cutting  rooms  in — 
(a)  Winter. 
(6)  Summer. 
Methods  of  ventilation. 
Respirator  devices  described. 
Habits  of  workers. 
Use  of  exhaust  devices. 
110459—19 2 


8  MORTALITY  FROM  TUBERCULOSIS  IN  DUSTY  TRADES. 

Under  date  of  December  26,  1917,  Dr.  E.  R.  Baldwin  amplified 
his  previous  communication  in  part  as  follows : 

Your  suggestions  about  the  scope  of  the  investigation  are  certainly  very  interesting 
and  valuable.  The  bearing  of  this  problem  upon  organic  dust  is  of  course  so  wide- 
spread, and  I  have  so  little  knowledge  on  it,  that  I  think  I  could  be  of  very  little  use 
in  that  particular  in  my  situation.  There  is  one  point  that  occurred  to  me  in  con- 
nection with  the  investigation  of  industries,  and  that  is  the  possibility  that  the  United 
States  Public  Health  Service  would  be  engaged  in  the  same  thing  and  possibly  at 
the  same  time,  or  if  not,  would  have  plans  for  this  work. 

I  have  no  doubt  that  your  forthcoming  statistical  study  would  be  the  best  starting 
point  of  any  investigation,  and  until  this  is  available  I  presume  there  will  be  little 
done.  I  was  assured  by  Dr.  Caverly  in  Vermont  of  the  cooperation  of  the  State 
board  of  health,  including  some  clerical  aid.  Dr.  Rogers,  superintendent  of  the 
sanatorium  in  Pittsford,  was  the  man  I  had  in  mind  to  take  charge  of  the  medical  and 
X-ray  work.  He  is  a  good  diagnostician,  but  would  need  assistance  and  guidance 
in  planning  out  a  survey.  The  Vermont  Marble  Co.  has  indicated  its  willingness 
to  give  us  every  facility,  but  the  granite  industry  is  less  easy  to  deal  with,  from  what 
I  have  heard. 

In  his  reply  to  this  letter,  under  date  of  January  3,  1918,  Dr.  Hoff- 
man enlarged  upon  certain  practical  aspects  of  the  proposed  investi- 
gation, in  part,  as  follows: 

I  am  obliged  to  you  for  your  favor  of  December  26  and  the  fairly  extended  expression 
of  your  views  regarding  the  plan  of  procedure  on  the  part  of  the  committee  on  dusty 
trades  most  likely  to  prove  productive  of  practical  and  early  results.  It  seems  to  me 
that  the  work  that  you  have  in  mind  is  most  promising  and  in  accordance  with  my 
own  ideas  regarding  the  prior  importance  which  should  be  given  to  the  stone  industry. 
I  feel  with  you  that  a  limited  but  thorough  investigation  of  a  few  typical  dusty  trades 
would  be  more  acceptable  to  the  association  than  a  rather  superficial  study  of  a  larger 
number  of  trades  and  occupations,  however  attractive  the  latter  might  be  from  other 
points  of  view.  A  considerable  amount  of  new  material  will  be  forthcoming  as  soon 
as  my  bulletin  on  The  Mortality  from  Respiratory  Diseases  in  Dusty  Trades  with 
Exposure  to  Inorganic  Dusts  is  published. 

In  your  letter  of  November  7  you  referred  to  the  favorable  attitude  of  the  Vermont 
Marble  Co.  and  the  anticipated  active  cooperation  of  the  Vermont  State  Board  of 
Health.  This  seems  to  me  a  most  auspicious  indication  of  the  assistance  which  will 
be  forthcoming  in  the  furtherance  of  our  plans  when  presented  in  the  proper  way  to 
those  directly  concerned.  It  has  always  been  my  own  method  to  utilize  such  agencies 
as  could  be  made  use  of  to  secure  the  information  desired  and  to  give  full  credit  for 
such  cooperation  in  the  conclusions  arrived  at.  In  Vermont  we  would  have  both 
the  marble  and  the  granite  industries,  and  possibly  some  attention  could  be  given  to 
slate  quarrying,  cutting,  etc.,  which  is  of  some  importance  in  that  State.  Of  the  slate 
sold  in  the  United  States  during  1915,  out  of  a  total  value  of  about  $5,000,000, 
$1,250,000  was  derived  from  Vermont.  The  production,  however,  has  been  declining 
in  that  State  during  recent  years.  Vermont  in  1915  was  the  fourth  most  important 
stone  producing  State,  being  slightly  exceeded  by  New  York  and  Ohio  but  con- 
siderably by  the  State  of  Pennsylvania.  There  were  49  active  plants  in  operation, 
indicating  that  the  number  employed  to  a  given  quarry,  mill,  etc.,  was  larger  than 
in  most  of  the  other  States.  In  granite  production,  however,  Vermont  was  the  leading 
State  in  1915;  in  marble  it  was  also  the  leading  State,  in  fact,  far  exceeding  in  the 
value  of  the  product  any  other  State.  It  would  therefore  seem  entirely  safe  to  assume 
that  conclusions  based  upon  an  investigation  in  Vermont  with  reference  to  the  granite 
and  marble  industries  and  possibly  with  reference  to  the  slate  industry  should  be 


MORTALITY  FROM  TUBERCULOSIS  IN  DUSTY  TRADES.  9s 

sufficiently  representative  for  the  country  at  large,  and  I  would  be  pleased  to  join 
with  you  in  an  active  effort  to  subject  the  local  conditions  to  a  thorough  investigation, 
in  so  far  as  our  own  office  can  be  of  assistance  to  you.  In  other  words,  I  would  be 
inclined  to  agree  that  at  the  outset  at  least,  or  say  for  the  present  year,  most  of  the 
work  of  the  committee  should  be  limited  to  the  State  of  Vermont,  more  or  less  in 
conformity  to  the  admirable  outline  attached  to  your  letter  of  November  7,  and  which 
bears  the  title  "Investigation  of  the  effect  of  the  marble  and  granite  industries  in 
tuberculosis." 

First  in  the  order  of  logical  procedure,  it  would  seem  to  me,  a  thorough  study  should 
be  made  of  working  methods  or  processes  and  labor  conditions.  How  far  present 
methods  have  been  made  a  matter  of  descriptive  accounts  in  trade  journals,  etc., 
I  am  not  aware,  but  I  feel  reasonably  sure  that  there  would  be  no  serious  difficulties 
in  obtaining  at  least  at  the  outset  a  fairly  comprehensive  account,  amplified  by  the 
required  illustrations  of  the  principal  machines  used  in  dry  cutting,  moist  cutting, 
etc.  In  this  connection  we  have  available  the  results  of  a  personal  investigation 
made  by  myself  some  years  ago  into  the  conditions  in  Vermont  and  of  which  we  will 
make  an  effort  to  secure  a  duplicate  copy  for  your  information.  As  regards  personal 
inquiry  among  employees  in  the  industries  referred  to  and  with  special  reference  to 
family  histories,  it  would  be  advisable  to  proceed  with  extreme  caution,  upon  the 
basis  of  an  exceptionally  carefully  considered  blank.  Many  such  investigations  have 
failed  in  the  past  in  that  either  the  blanks  themselves  were  improperly  worked  out 
or  that  the  inquiry  was  not  made  with  the  required  persistency.  We  had  some  ex- 
perience in  this  connection  with  an  investigation  made  by  Miss  Janice  Reed  in 
behalf  of  the  Phipps  Institute  in  the  clothing  industries  in  Philadelphia.  The  blanks 
and  forms  used  by  her  at  the  time  should  prove  useful  in  connection  with  the  Vermont 
investigation,  and  copies  thereof  will  be  obtained  and  forwarded  later  on,  together 
with  a  copy  of  the  report  itself,  with  reference  to  which  I  may  explain  that  the 
analysis  was  made  in  my  office  and  that  the  blanks  were  printed  at  our  expense  and 
the  work  itself  in  a  general  way  was  done  under  my  direction. 

The  same  observations  apply  to  house-to-house  censuses  by  medical  inspectors  with 
reference  to  the  present  and  past  illnesses  among  the  families  of  cutters.  I,  however, 
feel  that  the  entire  industry  should  be  included  in  this  investigation,  for  as  possibly 
to  be  emphasized  later,  occupational  changes  make  it  exceedingly  desirable  to  include 
those  who  are  now  perhaps  following  harmless  pursuits,  but  who  formerly  followed 
occupations  of  a  harmful  nature.  Collis,  in  the  Milroy  lectures  on  dust  phthisis, 
gives  as  an  illustration  the  case  of  a  lung  of  an  insurance  agent  who  for  eight  years 
before,  however,  had  been  a  miner  in  the  Transvaal,  etc.  If  the  autopsy  had  not 
been  made,  or  if  the  previous  occupation  had  not  been  ascertained,  the  conclusions 
in  either  event,  or  both,  would  have  been  misleading. 

I  construe  the  term  "race"  (under  letter  "6")  to  mean  racial  origin,  or,  rather, 
parent  nativity.  The  blank  should  show  the  birthplace  of  the  father  and  the  mother 
as  well  as  the  birthplace  of  the  person  questioned.  This  section  should  be  revised 
and  if  possible  made  more  specific,  so  as  to  admit  of  categorical  answers  more  suitable 
for  statistical  analysis. 

As  regards  the  medical  examination,  I  am  emphatically  of  the  opinion  that  if  any 
way  possible  all  employees  should  be  examined,  whether  they  show  symptoms  of 
past  history  of  chest  diseases  or  not.  The  method  pursued  by  the  miners'  phthisis 
commission  of  South  Africa  should,  if  possible,  be  followed  in  matters  of  detail,  so- 
that  if  practicable  the  results  may  be  comparable.  A  copy  of  the  report  of  the 
commission,  if  not  available  to  you,  can  be  loaned  to  you  by  the  library  of  the  United 
States  Commissioner  of  Labor  Statistics. 

The  same  observation  applies  to  the  determination  of  the  amount  (weight  and 
bulk)  of  the  dust  in  terms  of  cubic  feet  of  air  in  dry  cutting  rooms,  but  I  would 
broaden  this  to  include  all  cutting  rooms,  and,  furthermore,  that  the  determination 


10  MORTALITY  FROM  TUBERCULOSIS  IN  DUSTY  TRADES. 

be  in  conformity  to  the  more  or  less  standardized  method  of  the  South  African  inves- 
tigation or  the  Australian  investigation,  or  those  made  in  England  in  behalf  of  the 
Royal  Commission  on  Metalliferous  Mines 

The  methods  of  ventilation,  dust-exhaust  devices,  respirators,  of  different  types, 
habits  of  the  workers,  with  special  reference  to  dust  removal,  cleanliness  of  the  plant, 
sweeping,  etc.,  would  indicate  highly  differentiated  lines  of  inquiry,  which  it  would 
be  best  to  develop  with  increasing  experience  in  the  gathering  of  this  kind  of  infor- 
mation. It  is  possible  that  the  American  Museum  of  Safety  could  be  utilized  with 
reference  to  securing  a  complete  list  of  respirators,  of  which,  unfortunately,  a  large 
number  have  been  found  impracticable  in  actual  use  or  otherwise  objectionable  on 
the  part  of  the  workmen. 

A  collateral  study  should  be  pneumatic  tool  processes,  which,  of  course,  as  you 
know,  have  been  even  more  extensively  developed  in  connection  with  underground 
mining  than  with  cutting  and  polishing  in  the  stone  industries.  The  cooperation  of 
manufacturers  could,  no  doubt,  be  secured  later  on,  as  the  facts  would  develop,  for 
of  course  we  must  keep  in  mind  throughout  the  importance  of  practical  results.  It 
would  be  of  small  use  to  emphasize  an  evil  or  condemn  existing  processes  or  practices 
unless  an  alternative  could  be  suggested,  but  if  possible  one  acceptable  to  the  theo- 
retical as  well  as  eminently  practical  point  of  view. 

On  the  basis  of  the  foregoing,  I  shall  proceed  with  our  own  preliminary  office  inves- 
tigation. All  that  we  have  on  the  subject  of  the  granite  and  marble  industries  will  be 
brought  together  and  subjected  to  critical  consideration.  When  available  a  prelimi- 
nary report  will  be  sent  to  each  member  of  the  committee. 

Referring  now  to  your  letter  of  December  26,  it  seems  to  me  that  the  strictly  tech- 
nical work  should  be  entirely  under  your  personal  direction,  and  subsequently  we 
might  so  organize  our  committee  as  to  make  you  the  chairman  of  a  subcommittee  of 
one  on  medical  examinations  and  laboratory  analysis.  I  would  personally  be  willing 
to  take  charge  of  the  general  industrial  conditions,  working  processes,  and  sickness  and 
mortality  statistics.  After  you  have  worked  out  your  own  plans  somewhat  further 
and  mine  has  been  developed  a  meeting  could  be  arranged  for  either  at  Saranac  or 
perhaps  at  Burlington,  at  the  office  of  the  State  Board  of  Health,  to  be  followed  by  a 
joint  interview  with  the  managers  of  the  industries  whose  cooperation  has  been  prom- 
ised. I  should  judge  that  during  March  or  April  such  a  conference  could  be  arranged 
for  in  Vermont,  to  be  followed  later  by  others  as  occasion  may  require. 

In  the  meantime  the  fact  had  developed  that  an  exceptionally 
thorough  investigation  was  being  made  in  the  State  of  Indiana, 
jointly,  by  State  and  Federal  health  authorities,  etc.,  in  cooperation 
with  employers  of  labor  in  the  limestone  industry  of  southern  Indi- 
ana. Under  date  of  January  8,  1918,  the  following  letter  had  been 
received  by  the  chairman  from  Mr.  R.  M.  Richter,  the  secretary  of 
the  Bedford  Stone  Club  Auxiliary: 

Please  advise  us  whether  the  rate  you  make  stonecutters  differs  substantially  from 
rates  in  other  vocations.  If  there  is  a  difference,  we  would  be  glad  to  have  you  say, 
if  consistent,  why.  Are  there  any  reasons  other  than  the  prevalence  of  dust  in  some 
stone-working  establishments  which  perhaps  cause  you  to  discriminate  in  rates  or 
otherwise  against  this  class  of  labor?  A  prompt  reply  will  be  very  much  appreciated. 

To  this  letter,  under  date  of  January  15,  1918,  the  following  reply 
had  been  made,  though  limited,  of  course,  to  the  injurious  conse- 


MORTALITY  FROM  TUBERCULOSIS  IN  DUSTY  TRADES.  11 

quences  of  dust  inhalation,  which  in  the  investigation  under  way 
was  a  matter  of  minor  consideration: 1 

This  occupation  has  been  investigated  by  us  from  time  to  time  with  reasonable 
thoroughness,  but  not  sufficiently  so  to  justify  final  scientific  conclusions.  The  writer 
is  chairman  of  the  committee  on  the  Scientific  Investigation  of  the  Mortality  from  Res- 
piratory Diseases  in  Dusty  Trades  appointed  by  the  president  of  the  National  Tubercu- 
losis Association,  which  has  in  contemplation  an  original  investigation  along  strictly 
scientific  lines,  and  as  far  as  practicable  in  conformity  to  the  method  of  procedure  fol- 
lowed by  the  Phthisis  Commission  of  South  Africa.  The  writer's  earlier  observations 
and  statistical  data  are  contained  in  Bulletin  No.  79  of  the  United  States  Bureau  of 
Labor,  of  which  a  copy  may  possibly  be  obtained  through  the  Superintendent  of  Public 
Documents,  since  the  general  issue  has  long  been  exhausted.  A  revised  issue  is  now 
in  course  of  preparation  and  will  be  available  in  perhaps  six  months  in  proof  form 
through  the  courtesy  of  the  Commissioner  of  Labor  Statistics.  This  volume  is  exclu- 
sively devoted  to  mineral  dust.  The  data  and  observations,  however,  are  rather 
general,  since  an  opportunity  did  not  present  itself  to  go  into  the  details  by  means  of 
field  investigations,  which  would  have  required  visits  to  the  principal  centers  of  the 
etone  industry  and  a  reexamination  of  death  certificates  with  practicing  physicians 
familiar  with  the  facts  of  local  disease  incidence  and  its  relation  to  highly  specialized 
industrial  processes.  For  your  information  we  give  below  our  rating  practice  withi 
regard  to  stone  and  marble  workers,  as  published  in  our  latest  rate  book  (August,  1917) : 

Paving-stone  cutters '. Endowment  plans,  medium. 

Quarrymen,  open  or  surface  work Medium. 

Quarrymen  working  underground Endowment  plans,  medi um. 

Stonecutters  not  using  pneumatic  tools Endowment  plans,  medium. 

Stonecutters  using  pneumatic  tools Endowment  plans,  hazardous. 

Stone  sawyers,  and  lathe  workers,  polishers,  and  finishers. Endowment  plans,  medium. 
Tool  sharpeners Medium. 

These  ratings,  however,  are  not  conclusive  concerning  the  point  of  view  in  which  you 
are  likely  to  be  most  interested,  in  that  for  practical  reasons  we  can  not  differentiate- 
the  minor  employments  which  would  be  most  exposed  from  the  major  branches  of 
the  industry  with  a  relatively  small  degree  of  dust  exposure.  We  give  below  the 
premium  charge  at  age  30  for  the  different  classes  as  well  as  the  normal  charge  in 
or-cupations  without  exceptional  hazards: 

Annual  premium,  $1,000  insurance;  age  SO;  twenty-year  endowment. 

Regular  rate $42.  35 

Paving-stone  cutters 

Qtiarrymen   workin(r  underground . 
Stonecutters,  not  using  pneumatic  tools. 


Stone  sawyers,  lathe  workers,  polishers,  finishers,  and  tool  sharpeners 

Stone  cutters,  using  pneumatic  tools 47. 16 

From  a  letter  received  from  Mr.  Richter  under  date  of  January  19r 
1918,  in  reply  to  Dr.  Hoffman's  letter  of  January  15,  the  following 
extract  is  quoted,  as  an  illustration  of  views  pie\  ailing  at  the  present 

i  The  results  of  the  Indiana  investigation  have  since  been  published  as  Reprint  No.  460  of  the  United 
States  Public  Health  Service.  The  reprint  contains  three  reports,  respectively,  by  i  assed  Asst.  Burg. 
J.  P.  Leake,  on  "Health  hazards  from  the  use  of  the  air  hammer  in  cutting  Indiana  hmestone";  one  by 
Dr.  David  L.  Edsall,  on  "The  supposed  physical  effects  of  the  pneumatic  hammer  on  workers  in  Indiana 
limestone":  and  one  by  Dr.  Alice  Hamilton,  on  "The  effect  of  the  air  hammer  on  the  bands  of  stone- 
cutters." 


12  MORTALITY  FROM  TUBERCULOSIS  IN  DUSTY  TRADES. 

time  concerning  the  apparent  harmlessness  of  dust  inhalation  in 
consequence  of  the  use  of  pneumatic  tools  in  the  limestone  industry 

^x-r    cis\tt  4- V»  rt*»f\      I  ~n  r\  t  a  Y\  o  • 


of  southern  Indiana: 


Drs.  Barnes,  Leake,  and  Edsall  are  unanimous  in  their  finding  that  the  prevalence 
of  dust  in  the  mills  of  the  Indiana  limestone  district  is  a  negligible  factor.  This 
because  the  stone  as  worked  here  is  drenched  with  water  at  various  stages  of  fabrication, 
which  water  is  not  evaporated  to  any  extent  until  the  stone  is  practically  ready  for 
loading.  These  doctors  are  further  agreed  that  the  general  health  of  all  the  stone- 
cutters examined  and  interviewed  here  is  exceptionally  good  and  that  without  question 
or  doubt  they  rate  much  higher  in  that  regard  than  stonecutters  generally. 

It  seems  to  us,  therefore,  that  the  matter  to  which  we  refer  hereinbefore  must  be  of 
yital  interest  to  you.  Our  interest  in  it  is  twofold.  We  want  to  show  in  all  fairness  that 
the  effects  of  the  pneumatic  tool  are  not  such  as  to  warrant  discrimination.  We  want 
further  to  create  for  our  workmen  a  condition  which  will  give  them  every  benefit  so  far 
as  insurance,  among  other  things,  is  concerned,  which  may  rightly  accrue  from  the 
fact,  first,  that  the  pneumatic  tool  does  not  imply  hazard  and,  second,  that  in  our 
operations  in  Indiana  tuberculosis  owing  to  dust  is  practically,  if  not  entirely,  an 
unknown  experience. 

With  further  reference  to  this  exceptionally  favorable  view  regard- 
ing the  local  situation,  the  following  extract  from  a  letter  of  Mr. 
Richter's  dated  January  25,  1918,  is  also  included: 

When  you  come  to  Bedford,  you  will  find  the  mills  are  almost  altogether  of  a  strictly 
up-to-date  character,  so  far  as  equipment  in  general  and  working  conditions  are  con- 
cerned. As  a  matter  of  fact,  we  believe  we  can  show  with  some  force  that  in  the 
absence  of  a  personal  examination  of  the  facilities  here  no  true  conclusion  can  be 
reached  regarding  our  particular  situation.  In  passing,  we  want  to  refer  to  the  fact 
that  tuberculosis  unquestionably  is  far  more  prevalent  in  the  granite  and  sandstone 
industries  than  in  the  Indiana  limestone  industry.  Not  only  are  our  accommodations 
more  modern  than  generally  found  elsewhere,  but  the  nature  of  the  stone  itself  is  such 
as  to  preclude  most  of  the  detrimental  elements  which  are  a  source  of  objection  in  other 
sections  of  the  business.  Indiana  limestone,  as  commonly  worked,  is  moist,  in  fact, 
one  may  say,  wet.  Furthermore,  its  physical  make-up  is  such  as  to  cause  an  almost 
total  absence  of  sharp,  gritty  particles  which,  according  to  my  understanding,  are  the 
chief  objection  in  granite  and  sandstone.  I  have  in  mind,  upon  the  occasion  of  your 
visit  here,  whenever  it  is,  to  call  a  meeting  of  all  the  cut-stone  firms,  so  that  if  you  care 
to  you  can  give  them  a  talk  on  the  whole  proposition,  or  at  least  as  far  as  you  may  wish 
to  go  into  it. 

In  the  meantime  correspondence  had  been  had  with  the  general 
secretary  and  treasurer  of  the  Journeymen  Stonecutters'  Association 
of  North  America,  Mr.  Walter  W.  Drayer,  of  Indianapolis,  under 
date  of  February  2,  1918,  reading  as  follows: 

Replying  to  your  favor  of  the  29th  ultimo,  will  say  that  I  have  no  special  reports  as 
to  the  health  and  to  the  injuries  suffered  by  our  members  from  the  use  of  the  pneumatic 
hammer.  It  is  true  that  our  members  do  suffer  a  partial  paralysis  of  the  hands  in  the 
use  of  the  pneumatic  hammer,  and  this  condition  has  brought  forth  a  determined 
complaint  by  our  membership.  However, 'we  have  no  data  to  submit  at  this  time,  but 
within  the  course  of  the  next  few  weeks  the  Department  of  Labor  will  issue  a  special 
bulletin  upon  the  subject,  the  department  at  this  time  being  engaged  in  conducting  a 
rigid  examination  to  determine  just  the  effect  of  the  use  of  this  tool  upon  the  man 
who  uses  it. 


MORTALITY  FEOM  TUBERCULOSIS  IN  DUSTY  TRADES.  13 

To  the  foregoing  letter  the  following  reply  was  made  under  date  of 
February  6,  1918: 

We  are  obliged  to  you  for  your  favor  of  February  2,  and  the  information  contained 
therein  regarding  the  forthcoming  report  of  the  Bureau  of  Labor  Statistics  on  the  effects 
of  the  use  of  the  pneumatic  hammer  on  certain  bodily  functions,  especially  the  use  of 
the  hands  and  the  arms.  We  hope  to  have  an  opportunity  to  examine  this  report  in  the 
near  future  at  Dr.  Meeker's  office  in  Washington.  I  have  arranged  for  an  interview 
with  Dr.  Hamilton,  with  whose  work  we  are  thoroughly  familiar. 

It  has  occurred  to  the  writer  that  perhaps  you  would  be  willing  to  discuss  this 
matter  with  the  undersigned,  not  only  as  regards  the  rather  limited  aspects  of  the 
particular  question  just  referred  to,  but  as  to  the  broader  questions  involved,  such  as 
the  general  mortality  of  stonecutters  in  Indiana,  the  apparent  excess  from 
pulmonary  tuberculosis  and  other  respiratory  diseases,  etc.  The  general  subject  of 
stoneworkers'  mortality  will  be  discussed  in  a  forthcoming  bulletin  of  mine  on  The 
Mortality  from  Respiratory  Diseases  in  Dusty  Trades,  limited  for  the  present  to  dust 
of  mineral  origin. 

Does  your  association  transact  life  insurance  or  does  it  grant  sick  benefits,  and,  if 
so,  are  the  mortality  or  morbidity  data  available  in  a  form  for  statistical  analysis? 
If  your  association  should  have  a  considerable  amount  of  information  on  the  subject 
it  might  be  feasible  for  the  committee  and  our  company  to  cooperate  so  as  to  bring  to 
light  much  useful  information  on  the  health  of  the  men  in  this  industry  or  rather  the 
possible  health-injurious  aspects  of  the  work  in  which  they  are  engaged.  The  com- 
mittee on  the  scientific  study  of  the  dusty  trades  with  special  reference  to  tuberculosis 
recently  appointed  by  the  National  Association  for  the  Study  and  Prevention  of 
Tuberculosis,  and  of  which  I  have  the  honor  to  be  the  chairman,  is  most  anxious  to 
secure  the  cooperation  of  your  association,  aside  from  the  cooperation  which  is  likely 
to  be  extended  to  us  by  the  State  board  of  health  and  the  leading  stone  producing 
industries. 

In  connection  with  our  investigation  I  expect  to  visit  Indiana  and  I  could,  of 
course,  easily  arrange  to  see  you  and  discuss  this  matter  in  more  detail.  I  rather 
regret  to  learn  that  you  have  as  yet  made  no  special  investigation  on  your  own  part 
as  to  the  health  and  the  injuries  suffered  by  your  own  employees  from  the  use  of 
pneumatic  tools,  but  possibly  this  reference  does  not  cover  the  broader  question  of 
health-injurious  conditions  in  the  stone  industry  of  Indiana  in  general. 

To  this  letter  Mr.  Drayer,  February  9,  1918,  replied  at  consider- 
able length.  His  letter  is  a  notable  contribution  to  the  scientific 
study  of  industrial  diseases  from  the  labor  point  of  view,  and  the 
letter  is  given  in  its  entirety,  even  though  some  of  the  observations 
relate  to  the  physical  effects  of  the  use  of  the  pneumatic  hammer  on 
the  health  of  the  workers  in  Indiana  limestone  as  a  problem  sepa- 
rate and  distinct  from  the  broader  questions  involved  in  the  present 
discussion : 

Your  valued  favor  of  the  6th  instant  at  hand  this  morning  and  contents  very  care- 
fully noted.  In  reply  will  say  that  I  will  cheerfully  favor  you  with  any  information 
we  have  relative  to  the  use  of  the  air  or  pneumatic  hammer  and  the  physical  injuries 
suffered  by  our  members  who  use  it,  also  any  data  you  may  desire  as  to  the  mortality 
of  our  membership. 

With  reference  to  the  air  hammer,  it  has  been  a  momentous  question  with  our 
membership  for  the  past  five  years,  owing  to  its  almost  universal  installation  in  many 
localities  throughout  the  country.  We  have  not  conducted  any  specific  investigations 
in  regard  to  this  tool  for  several  reasons,  namely,  that  the  employers  maintain  that 


14  MORTALITY  FROM  TUBERCULOSIS  IN  DUSTY  TRADES. 

our  opposition  to  the  tool  is  solely  because  it  has  proved  efficient  and  that  we  are 
afraid  it  will  displace  a  number  of  our  mechanics;  that  no  matter  how  unprejudiced 
an  investigation  we  might  conduct,  the  employers  would  go  to  extremes  to  discredit  it; 
that  the  subject  to  us  is  one  that  needs  no  specific  investigation,  inasmuch  as  fully 
90  per  cent  of  our  members  who  have  been  using  this  tool  for  a  year  or  more  show  the 
visible  effects  which  can  not  be  denied,  inasmuch  as  the  circulation  in  their  hands 
and  arms  becomes  stagnant  and  as  a  result  on  a  cold  and  damp  morning  their  hands 
and  fingers  seem  absolutely  lifeless,  turning  a  pale  white  color,  best  illustrated  by 
comparing  it  to  the  hands  of  a  corpse.  We  have  therefore  prevailed  upon  the  United 
States  Government  to  make  an  investigation  of  this  general  complaint,  knowing  that 
such  report  could  not  be  discredited  by  the  employers,  which  would  be  the  case 
should  we  conduct  an  investigation.  I  am  by  this  mail  forwarding  you  copies  of 
our  1917  Journals  in  which  I  have  marked  several  articles  bearing  upon  our  observa- 
tion of  the  use  of  this  tool,  also  containing  general  summary  of  Dr.  Charles  Cottingham, 
of  this  city,  whom  we  employed  to  make  an  examination  of  some  seven  or  eight  of  our 
members.  In  these  Journals  you  will  also  find  extracts  of  items  appearing  in  the 
"Minutes,"  a  pamphlet  published  by  the  International  Cut-Stone  Contractors  and 
Quarrymen's  Association.  By  writing  to  Mr.  Win.  A.  Guthrie,  secretary  of  the 
International  Cut-Stone  Contractors  and  Quarrymen's  Association,  1  East  Forty- 
second  Street,  New  York  City,  you  might  be  able  to  get  the  back  numbers  of  this 
publication  and  thus  obtain  a  clear  understanding  of  the  attitude  of  the  employers 
upon  this  tool. 

As  to  the  susceptibility  of  our  members  to  tuberculosis,  I  may  advise  you  that  a 
few  years  back,  when  a  great  deal  of  the  work  was  in  sandstone,  the  death  rate  of  our 
members  from  tuberculosis  was  alarming.  However,  of  late  years  sandstone  has  not 
been  so  extensively  used,  Indian  oolitic  limestone  in  a  great  measure  supplanting 
the  use  of  sandstone,  and  as  the  bulk  of  the  work  in  Indiana  limestone  is  done  with 
machines  and  the  analysis  shows  limestone  to  be  composed  of  about  98  per  cent  lime, 
we  find  that  our  death  rate  of  tuberculosis  is  steadily  decreasing.  I  might  add,  though, 
that  the  use  of  the  pneumatic  hammer  subjects  our  members  to  more  danger  in  the 
contracting  of  tuberculosis  than  do  the  tools  of  our  trade— the  mallet  and  hammer — 
inasmuch  as  the  vibration  or  stroke  of  this  hammer  is  constant,  thus  emitting  a 
steady  stream  of  this  fine  dust  into  the  face  and  nostrils  of  the  operator,  while  with 
the  tools  of  the  trade  there  was,  of  course,  an  interval  between  the  blows  which  gave 
the  dust  some  opportunity  of  being  carried  away  in  the  air. 

We  have  since  the  organization  of  our  association  paid  our  members  a  death  bene- 
fit, and  of  course  a  record  has  been  kept  of  all  such  claims.  I  am  sorry  to  say,  how- 
ever, that  this  record  was  not  in  the  past  kept  in  the  complete  manner  it  should  have 
been  kept,  as  a  great  number  of  deaths  recorded  do  not  show  causs  of  death  and  age 
of  deceased.  However,  a  majority  of  the  deaths  show  a  complete  record  and  it  is, 
of  course,  possible  to  obtain  statistics  on  the  percentage  thus  reported. 

I  note  that  you  are  contemplating  a  visit  to  Indiana,  and  if  you  will  visit  this  city 
during  your  investigation  in  the  State  I  will  be  only  too  pleased  to  meet  you  and 
give  you  all  information  possible.  In  the  meantime  it  is  possible  that  I  will  be  in 
New  York  some  time  during  the  month  and  if  agreeable  I  would  be  pleased  to  call 
at  your  office  and  talk  over  these  subjects  with  you,  as  it  is  evident  that  we  must 
obtain  some  relief  from  the  present  inhuman  manner  in  which  a  number  of  the  em- 
ployers would  force  our  members  to  use  thesa  tools.  I  feel  satisfied  that  should  you 
see  Dr.  Meeker  and  Dr.  Hamilton  they  will  be  in  a  position  to  supply  you  with  much 
valuable  information  relative  to  the  air  hammer  and  we  are  very  much  in  hope  that 
the  medical  examination  of  several  of  our  members  now  being  conducted  in  Chicago 
by  Dr.  Rothstein  will  be  shortly  completed  so  that  we  may  get  the  complete  report 
of  the  Bureau  of  Labor  Statistics  upon  this  subject. 

Assuring  you  that  I  am  only  too  pleased  to  assist  you  in  any  way  possible  in  your 
investigation  of  health  conditions  in  the  stone  trade  in  Indiana,  I  am,  etc. 


MORTALITY  FROM  TUBERCULOSIS  IN  DUSTY  TRADES.  15 

The  reply  to  the  foregoing  communication,  under  date  of  February 
15,  1918,  reads  in  part  as  follows: 

It  was  very  good  of  you  to  write  to  me  at  length  regarding  the  subject  matter  referred 
to  in  my  letter  to  you  of  February  6.  Your  presentation  of  the  matter  in  controversy 
is  an  admirable  indication  of  your  sense  of  fairness  and  your  desire  to  have  the  true 
state  of  affairs  ascertained  by  means  of  an  impartial  inquiry.  You  have  certainly 
adopted  probably  the  only  course  open  to  you  by  making  use  of  the  expert  services 
available  through  the  Bureau  of  Labor  Statistics.  There  is  not  a  more  qualified 
person  in  this  country  in  connection  with  such  matters  than  Dr.  Alice  Hamilton  and 
her  report  will  unquestionably  set  forth  the  facts  in  the  case  with  scrupulous  accuracy 
and  scientific  collusiveness.  Of  course,  in  every  question  of  this  kind  there  are 
matters  in  controversy  which  permit  of  more  than  one  well-considered  point  of  view, 
so  that  it  is  most  desirable  indeed  that  the  manufacturers,  on  their  own  account, 
should  have  initiated  similar  inquiries,  which  ought  to  prove  productive  of  good 
results.  I  understand  that  they  have  retained  Dr.  Edsall,  who  is  one  of  the  foremost 
authorities  on  occupational  diseases  and  whose  judgment  and  conclusions  should  be 
of  real  value. 

Mr.  Drayer  made  anwser  to  the  preceding  communication  under 
date  of  February  23,  1918,  but  on  account  of  urgent  office  matters 
the  proposed  conference  could  not  be  arranged  for,  nor  could  the 
contemplated  investigation  in  Indiana  be  carried  out  at  the  tune, 
although  additional  assurances  of  local  cooperation  had  been  re- 
ceived from  Dr.  J.  N.  Hurty,  the  secretary  of  the  Indiana  State 
Board  of  Health: 

Your  valued  favor  of  the  15th  instant  at  hand  and  contents  carefully  noted.  In 
reply  will  say  that  just  as  soon  as  I  have  the  opportunity  of  being  in  New  York  City 
I  will  call  you  over  the  phone  and  make  arrangements  to  meet  you  either  in  New 
York  or  at  your  office  in  Newark. 

I  fully  expected  to  be  in  New  York  prior  to  the  end  of  this  month.  My  mission 
there  was  in  connection  with  a  matter  in  the  Federal  court,  but  I  believe  there  has 
been  some  postponement  of  the  case,  and  I  can  not  predict  just  when  the  matter  will 
again  come  up. 

However,  just  as  soon  as  I  have  occasion  to  visit  New  York  I  will  get  in  touch  with 
you  and  will  be  pleased  to  bring  along  such  records  of  our  association  as  will  enable 
you  to  draw  conclusions  as  to  the  percentage  of  our  members  who  have  died  of  tuber- 
culosis as  a  result  of  the  dust  connected  with  the  cutting  of  stone. 

(Useful  references  but  particularly  with  regard  to  the  effect  of  the  air  hammer  on 
the  hands  of  stonecutters,  but  with  some  observations  on  pulmonary  tuberculosis, 
occur  in  the  January,  March,  May,  June,  August,  and  September,  1917,  issues  of  The 
Stonecutters'  Journal.) 

The  preliminary  work  having  been  completed  the  first  meeting  of 
the  committee  was  called  to  be  held  at  Saranac  Lake,  following  the 
executive  committee  of  the  National  Tuberculosis  Association, 
called  for  July  13,  1918.  In  a  communication  to  the  members  of 
the  committee,  dated  June  25,  1918,  the  proposed  plan  of  investiga- 
tion was  briefly  outlined  as  follows: 

This  is  to  inform  you  that,  if  in  any  way  possible,  a  meeting  of  the  committee  on 
dusty  trades  will  be  held  at  Saranac  Lake  either  before  or  after  the  meeting  of  the 
executive  committee.  Since  at  this  time  the  date  is  somewhat  uncertain,  but  tenta- 
tively assumed  to  be  July  13,  the  meeting  could  probably  be  held  Sunday  after- 


16  MORTALITY  FROM  TUBERCULOSIS  IN  PUSTY  TRADES. 

noon  or  perhaps  Saturday  evening.  Dr.  B.  R.  Baldwin  has  been  at  work  on  experi- 
mental research,  in  cooperation  with  the  State  Board  of  Health  of  Vermont,  and 
no  doubt  definite  recommendations  could  be  made  as  to  the  .nature  of  the  work  to  be 
taken  up  by  the  committee.  Dr.  Lanza,  of  the  Public  Health  Service,  in  cooperation 
with  associates  of  the  Bureau  of  Mines,  has  just  published  a  report  on  Silicious  Dust  in 
Relation  to  Pulmonary  Disease,  which  should  be  useful.  Much  to  my  regret  my  own 
rather  extended  report  on  Occupations  with  Exposure  to  Inorganic  Dusts  and  Their 
Relation  to  Pulmonary  Diseases  is  not  yet  available,  but  the  final  page  proof  has  been 
released  for  the  Public  Printer. 
The  main  questions  to  be  taken  up  are,  briefly,  as  follows: 

1.  What  occupations  or  industries  should  be  taken  up  at  the  outset?    Would  it  not 
be  possible  to  limit  the  work  of  the  committee  at  this  time  to  certain  well-defined 
employments  in  the  stone  industries,  such  as  the  marble  and  granite  quarries  of  Ver- 
mont, the  limestone  industries  of  southern  Indiana,  the  zinc  and  lead  mines  of  south- 
western Missouri,  and  possibly  the  cement  industries  and  perhaps  the  slate  industries 
of  Pennsylvania? 

2.  How  far  would  it  be  possible  to  secure  the  active  cooperation  of  the  State  Boards 
of  Health  of  Vermont,  Pennsylvania,  Indiana,  and  Missouri?    Some  gratifying  assur- 
ances have  been  received,  especially  from  Vermont  and  Indiana. 

3.  What  field  investigations  should  be  undertaken  at  this  time  and  how  far  would 
it  be  possible  or  practicable  to  secure  the  active  cooperation  of  the  Federal  Health 
Department,  the  Bureau  of  Labor  Statistics,  the  Bureau  of  Mines,  etc.? 

4.  How  far  would  it  be  possible  for  the  Trudeau  Foundation  to  cooperate,  or  con- 
versely, in  what  direction  could  the  work  of  the  committee  be  best  coordinated  to  the 
admirable  work  which  is  being  done  by  Dr.  Baldwin  and  his  associates? 

5.  Would  it  be  feasible — and  if  so,  would  it  be  advisable — to  undertake  a  special 
analysis  of  death  certificates  in  certain  centers  of  the  stone  or  cement  industries  for 
the  purpose  of  subjecting  the  data  to  a  qualified  examination,  especially  as  regards 
accuracy  in  occupational  returns  and  accuracy  in  the  clinical  diagnosis  and  correctness 
in  death  certification? 

6.  How  far  would  it  ba  possible  to  take  up  the  question  of  autopsies,  especially 
with  the  cooperation  of  the  Henry  Phipps  Institute  and  possibly  the  Mellen  Institute 
of  Pittsburgh?    The  occupational  disease  clinic  of  the  University  of  Pennsylvania 
might  also  be  utilized.    A  question  which  might  be  taken  up  would  be  as  to  how  far 
a  thoroughly  complete  series  of  autopsies  of  stone  and  cement  workers,  including 
miners,  could  be  brought  together,  amplified  by  a  complete  chemical  analysis  of  the 
lungs,  in  conformity  to  the  procedure  of  the  miners'  phthisis  commission  of  South 
Africa,  etc.     If  a  descriptive  account  of  even  only  a  score  of  such  lungs  could  be 
secured  with  full  occupational  details,  dust  exposure,  occupational  processes,  etc., 
much  new  knowledge  might  be  gained. 

7.  How  far  would  it  be  possible — and  if  so,  desirable — to  take  into  special  account 
the  question  of  the  degree  of  fineness  or  minuteness  01  size  of  the  dust  particles  inhaled 
under  different  occupational  conditions  as  different  and  distinct  from  the  quantative 
determination  of  the  dust  contents  both  of  the  air  and  the  lungs,  as  has  usually  hereto- 
fore been  the  case  in  investigations  of  this  kind?    The  work  of  the  South  Africa  Com- 
mission seems  to  have  proved  conclusively  that  the  degree  of  fineness  or  minuteness 
of  the  dust  particles  is  of  far  greater  importance  than  the  mere  quantity  of  the  dust 
inhaled  during  different  occupational  processes. 

These  are  merely  tentative  suggestions  so  as  to  provide  an  orderly  basis  of  procedure 
for  the  deliberations  of  the  committee.  Any  other  questions  could  of  course  be  brought 
up  at  the  meeting. 

At  the  meeting  the  following  brief  report,  which  was  originally 
communicated  to  the  executive  committee  under  date  of  March 
15,  1918,  summarized  what  had  thus  far  been  done: 


MORTALITY  FROM  TUBERCULOSIS  IN  DUSTY  TRADES.  17 

REPORT    OP    THE    CHAIRMAN    OP   THB    COMMITTEE    ON    THE    SCIENTIFIC    INVESTIGATION 
OP  THE  MORTALITY  PROM  TUBERCULOSIS  IN  DUSTY  TRADES. 

There  has  thus  far  been  no  meeting  of  the  committee,  but  a  rather  extended  corre- 
spondence has  been  carried  on  with  the  members,  who,  one  and  all,  are  showing  an 
active  interest  in  the  proposed  investigation.  Dr.  Alice  Hamilton  has  accepted 
membership  and  her  cooperation  will  be  most  useful.  She  has  agreed  to  include  a 
study  of  the  question  of  tuberculosis  in  its  relation  to  the  use  of  pneumatic  tools  in 
her  general  investigation  of  the  stone  industry  in  Vermont.  For  the  time  being  atten- 
tion is  concentrated  upon  the  limestone  industry  in  southern  Indiana.  Most  gratifying 
assurances  of  cooperation  have  reached  us  from  manufacturers  and  labor  unions,  as 
well  as  from  the  United  States  Bureau  of  Labor  Statistics  and  the  United  States 
Public  Health  Service,  which  are  at  present  engaged  in  a  thorough  scientific  study 
of  the  mechanical  effects  of  pneumatic  tools.  The  investigations  will  be  enlarged  in 
certain  directions,  in  accordance  with  our  suggestion,  to  include  the  subject  of  tuber- 
culosis. It  had  been  the  intention  of  the  chairman  to  make  a  personal  investigation 
in  southern  Indiana  before  this,  but  it  is  doubtful  whether  this  can  be  done  before 
May  or  June.  Among  other  conferences  was  one  recently  held  with  Dr.  Leake,  of 
the  United  States  Public  Health  Service,  whose  investigations  in  southern  Indiana 
included  the  question  of  tuberculosis  and  whose  preliminary  report  will  be  published 
in  the  near  future. 

The  outlook  is  therefore  encouraging  that  really  useful  work  will  be  done  by  the 
committee  during  the  summer  months.  In  the  meantime  the  chairman's  rather 
extended  report  on  the  Mortality  from  Respiratory  Diseases  in  the  Dusty  Trades, 
with  special  reference  to  Inorganic  Dusts,  in  course  of  publication  by  the  United 
States  Bureau  of  Labor  Statistics,  is  reaching  completion,  and  should  be  available 
before  June  1. 

Respectfully  submitted. 

FREDERICK  L.  HOFFMAN, 
Chairman  Committee  on  Mortality  from  Tuberculosis  in  Dusty  Trades, 

National  Association  for  Study  and  Prevention  of  Tuberculosis. 

Under  date  of  July  17,  1918,  the  minutes  of  the  meeting  and  the 
results  of  the  conference  were  communicated  to  the  president  of  the 
association,  as  well  as  to  the  members  of  the  committee,  for  future 
reference  and  as  a  basis  for  future  deliberations,  as  follows: 

Dr.  DAVID  R.  LYMAN, 

President,  National  Tuberculosis  Association, 

Wallingford,  Conn. 

MY  DEAR  DOCTOR  LYMAN:  The  following  is  a  brief  statement  of  the  conclusions  and 
recommendations  arrived  at  by  the  Committee  on  the  Scientific  Investigation  of  the 
Mortality  from  Tuberculosis  in  Dusty  Trades,  at  their  recent  meeting  at  Saranac  Lake, 
with  such  observations  concerning  matters  of  detail  as  may  prove  useful  as  a  matter 
of  record. 

The  meeting  was  participated  in  by  Dr.  A.  J.  Lanza,  of  the  United  States  Public 
Health  Service;  Dr.  Edward  R.  Baldwin,  of  Saranac  Lake;  Dr.  Alice  Hamilton,  of 
Hull  House,  Chicago;  Dr.  O.  W.  McMichael,  of  Asheville,  N.  C.;  and  by  invitation, 
Dr.  Charles  S.  Caverly,  president  of  the  Vermont  State  Board  of  Health;  and  Dr. 
Gardner,  of  the  Research  Department  of  the  Trudeau  Foundation,  Saranac  Lake. 

In  a  general  way,  the  committee  considered  first  the  question  as  to  what  occupations 
or  industries  should  be  taken  up;  second,  what  special  aspects  of  the  problem  should 
be  given  priority;  third,  what  special  methods  of  investigation,  if  any,  should  be  fol- 
lowed; and,  fourth,  what  official  or  private  assistance  or  cooperation  should  be  secured. 


18  MORTALITY  FROM   TUBERCULOSIS  IN  DUSTY  TRADES. 

The  committee  took  cognizance  of  an  investigation  contemplated  by  Dr.  E.  R. 
Baldwin  and  his  associates  in  hehalf  of  the  Trudeau  Foundation  into  the  relation  of 
the  marhle  and  granite  industries  to  tuberculosis,  with  special  reference  to  the  State 
of  Vermont.  In  the  furtherance  of  this  plan,  presented  in  some  detail  and  placed 
before  the  committee  for  its  consideration,  the  active  cooperation  of  the  State  Board 
of  Health  of  Vermont  had  been  secured,  as  well  as  that  of  the  Vermont  Marble  Co., 
and  particularly  that  of  its  representative,  Mr.  Frank  C.  Partridge. 

The  importance  of  the  stone  industries  in  their  relation  to  the  tuberculosis  problem 
was  emphasized  by  the  chairman,  who  directed  attention  to  a  forthcoming  and  rather 
extended  publication  of  the  United  States  Bureau  of  Labor  Statistics,  on  the  mortality 
from  respiratory  diseases  in  their  relation  to  the  dusty  trades,  limited,  however,  to 
inorganic  dust.  The  evidence  brought  together  in  this  work  fully  sustains  the  view- 
point of  Dr.  Baldwin  and  others,  that  if  at  all  practicable,  the  stone  industries,  and 
particularly  the  marble  and  granite  industries,  should  be  given  priority  in  the  delib- 
erations of  the  committee. 

Dr.  Caverly  presented  a  statistical  statement  regarding  the  stone  industries  of  the 
State  of  Vermont,  pointing  out  in  detail  that  the  number  of  granite  cutters  in  the 
Barre  district,  including  helpers,  and  men  employed  in  quarries,  was  approximately 
5,000.  In  the  city  of  Barre,  with  a  population  in  1910  of  10,784,  there  had  been  135 
deaths  from  all  causes,  and  that  of  this  number  28,  or  20.7  per  cent,  had  been  caused 
by  tuberculosis  of  the  lungs;  and  33,  or  24.4  per  cent,  by  some  form  of  tuberculosis. 
This  excessive  proportion  of  deaths  from  tuberculosis  was  fully  sustained  by  the  evi- 
dence in  detail,  and  for  a  period  of  years  regarding  the  frequency  of  tuberculosis 
among  the  general  population  of  the  granite-cutting  industries,  not  only  of  Vermont, 
but  of  the  country  at  large.  It  was  agreed  as  a  tentative  conclusion  that  mechanical 
and  other  operations  necessary  in  the  conduct  of  the  stone-cutting  industry  were  in 
some  way  and  in  some  measure,  and  possibly  in  a  large  measure,  responsible  for  the 
excess  in  the  frequency  of  tuberculosis  occurrence  in  the  stone-cutting  sections  of  the 
State  of  Vermont. 

Regardless  of  the  frequency  of  tuberculosis  in  the  .stone-cutting  sections,  counties 
or  towns,  of  the  total  number  of  admissions  to  the  State  sanatorium  for  incipient  tuber- 
culosis during  a  period  of  about  ten  and  a  half  years,  and  numbering  963  patients, 
only  56,  or  5.8  per  cent,  have  been  granite  cutters,  granite  workers,  or  quarrymen. 
In  addition  thereto,  the  number  of  marble  tracers,  graders,  polishers,  cutters,  and 
workers  admitted  to  the  institution  since  its  opening  has  been  only  10.  In  view  of 
the  fact  that  these  two  stone  industries  are  probably  the  most  important  industrial 
enterprises  in  the  State,  it  is  self-evident  that  the  institution  is  not  being  utilized  as 
much  as  it  should  be,  and  most  of  all  not  on  the  part  of  those  afflicted  workers  suffering 
from  the  disease  in  the  incipient  and  curable  stages. 

Dr.  Caverly,  in  conclusion,  stated  that  the  outlook  was  encouraging  that  the  manu- 
facturers, especially  those  engaged  in  the  marble  industries,  would  welcome  a  scientific 
investigation,  and  that  a  similar  amount  of  support  would  probably  be  forthcoming 
with  the  Granite  Manufacturers'  Association,  and  especially  its  secretary,  Mr.  Hinman, 
of  Barre  City. 

Dr.  Baldwin  said  in  this  connection  that  much  valuable  assistance  could  be  rendered 
through  the  Vermont  Sanatorium  at  Pittsford,  and  particularly  its  resident  physician, 
Dr.  E.  J.  Rogers,  whose  services  might  be  made  available  through  the  cooperation  of 
the  Trudeau  Foundation  in  the  direction  of  certain  highly  specialized  phases  of  field 
research. 

Dr.  Lanza  raised  the  general  question  as  to  the  use  of  pneumatic  tools  and  the  best 
possible  means  of  reducing  or  controlling  the  health-injurious  consequences  of  their 
extensive  employment  in  the  stone  industry.  Dr.  Caverly  called  attention  to  a  safety 
device  which,  a  few  years  ago,  had  been  offered  but  had  been  rejected  on  the  ground 
that  it  materially  increased  the  weight  of  the  tools  and  was  therefore  objectionable 


MORTALITY  FROM  TUBERCULOSIS  IN  DUSTY  TRADES.  19 

to  the  employees.  He  agreed  to  furnish  a  photograph  of  the  proposed  device,  with  a 
view  to  a  further  consideration  of  this  question,  particularly  on  the  part  of  the  manu- 
facturers, especially  the  Ingersoll-Rand  Co.  Dr.  Caverly  also  recalled  that  at  the 
time  a  fairly  extensive  correspondence  had  been  had  with  those  directly  interested 
in  the  problem  and  possibly  some  of  this  correspondence  might  later  be  made  available 
to  the  committee. 

Dr.  Hamilton  referred  briefly  to  her  investigations  in  the  Barre  district,  limited, 
however,  largely  to  the  mechanical  injuries  resulting  from  the  use  of  pneumatic  tools 
and  made  only  incidentally  with  reference  to  the  dust  hazard  and  its  relation  to  the 
occurrence  of  pulmonary  tuberculosis.  She  gave  expression  to  the  view  that  the  labor 
unions  would  be  favorable  to  an  investigation  if  approved  of  by  the  president  of  the 
International  Union,  with  headquarters  at  Quincy,  Mass.  It  was  felt  by  all  those 
present  that  the  fullest  cooperation  of  both  employers  and  employees  could  be  had 
•from  the  outset  in  any  possible  field  investigation. 

The  question  was  then  taken  up  as  to  the  first  section  of  Dr.  Baldwin's  proposed 
plan  of  investigation,  having  chiefly  to  do  with  external  or  environmental  factors, 
including  housing  conditions,  age,  race,  duration  of  employment,  etc.  It  was  agreed 
that  such  a  field  investigation  should  be  made  more  or  less  in  conformity  to  the  plan 
of  inquiry  followed  by  Dr.  Forrest  B.  Ames  in  his  "A  tuberculosis  survey  of  the  resi- 
dents of  Saranac  Lake,  New  York,"  made  available  to  the  members  as  a  reprint  from 
the  American  Review  of  Tuberculosis  for  June,  1918.  It  was  agreed,  however,  that 
the  blank  utilized  for  the  purpose  would  require  to  be  materially  modified,  and  it  was 
further  agreed  that  the  chairman  would  have  such  a  blank  prepared,  based  upon 
similar  inquiries  in  this  and  other  countries  arid  forward  tentative  copies  to  every 
member  of  the  committee  previous  to  the  next  meeting.  Dr.  Lanza  suggested  in  this 
connection  that  possibly  the  blanks  used  by  him  in  the  joint  investigation  of  the 
United  States  Bureau  of  Mines  and  the  United  States  Public  Health  Service,  in  south- 
west Missouri,  and  at  Butte,  Mont.,  might  be  utilized.  He  was  requested  to  forward 
-copies  of  such  blanks  to  the  chairman. 

Dr.  Caverly  then  suggested  that  possibly  the  State  health  inspectors  could  be  made 
use  of  in  securing  the  required  information  by  a  house-to-house  survey;  if  not  of  an 
entire  district  or  town,  at  least  of  a  typical  portion  thereof.  He  thought  further  that 
the  State  Tuberculosis  Department,  through  its  educational  division,  might  render 
useful  personal  assistance,  and  he  agreed  to  give  this  matter  further  consideration. 
Dr.  Lanza  said  that  on  the  basis  of  his  experience  woman  field  investigators  had  been 
iound  particularly  useful,  and  his  view  was  sustained  by  the  chairman  and  others 
present  participating  in  the  discussion.  Exceptional  care,  however,  would  be  required 
in  the  employment  of  a  field  worker,  aside  from  the  question  as  to  compensation  and 
•other  expenses.  Dr.  Caverly  suggested  the  preparation  by  the  chairman  of  a  brief 
memorandum  for  his  use  in  presenting  a  proposed  plan  of  cooperation  to  the  Vermont 
State  Board  of  Health  for  its  official  approval.  This  was  agreed  to  by  the  chairman, 
and  copies  of  such  a  memorandum  were  subsequently  to  be  sent  to  every  member  of 
the  committee. 

It  having  been  agreed  that  a  field  investigation  would  be  necessary  to  ascertain  the 
general  facts  of  the  industry  and  the  general  effects  of  the  employment  upon  the 
physical,  social,  and  economic  condition  of  the  people,  the  committee  proceeded  with 
a,  consideration  of  the  second  portion  of  Dr.  Baldwin's  outline,  concerning  chiefly  the 
medical  or  physical  examination  of  the  employees.  It  was  agreed  that  such  an  exami- 
nation should  be  made  of  as  large  a  number  of  employees  as  could  possibly  be  induced 
to  submit  to  a  thorough  examination.  Dr.  Hamilton  felt  that  if  the  cooperation  of 
the  Granite  Cutters'  Union  and  of  other  labor  unions  was  secured  the  difficulties  would 
not  be  as  serious  as  anticipated.  Dr.  Lanza  said  that  in  the  light  of  his  experience 
much  would  be  gained  if  the  physical  examinations  were  conducted  under  the  direct 
authority  of  some  member  of  a  department,  like  the  United  States  Public  Health 


20  MORTALITY  FROM  TUBERCULOSIS  IN  DUSTY  TRADES. 

Service,  the  United  States  Bureau  of  Mines,  or  the  United  States  Bureau  of  Labor 
Statistics,  rather  than  to  be  made  to  rest  entirely  upon  the  basis  of  a  private  and 
unofficial  initiative. 

Dr.  Baldwin  enlarged  upon  the  practical  side  of  the  required  Rontgen-ray  examina- 
tions, which  all  of  those  present  considered  absolutely  essential.  Reference  was  made 
to  the  elaborate  study  of  this  phase  of  the  problem  by  Drs.  Pancost  and  Miller,  and 
by  Dr.  Landis,  the  latter  being  a  member  of  the  committee,  but  unfortunately  unable 
to  be  present.  The  Trudeau  Sanatorium,  or  the  Trudeau  Foundation,  would  be 
willing  to  undertake  much  if  not  most  of  this  work  and  materially  share  in  the  expense. 
It  was  agreed,  however,  that  the  physical  examination  of  the  employees  should  follow 
the  field  investigation,  but  in  the  meantime  the  technical  details  of  such  an  investi- 
gation, with  special  relation  to  the  required  blank,  etc.,  would  receive  consideration. 
As  to  the  best  possible  blank  for  the  purpose,  it  was  agreed  that  the  chairman  should 
have  such  a  blank  prepared  on  the  basis  of  previous  investigations  in  this  country 
and  abroad,  and  Dr.  Lanza  promised  to  furnish  copies  of  the  blanks  used  by  him  in 
the  examination  of  some  1,500  miners  in  the  Butte  (Mont.)  district. 

Dr.  McMichael  agreed  to  report  possible  individual  cases  of  lung  fibrosis  and  pul- 
monary tuberculosis  obviously  in  consequence  of  dust  exposure,  although  he  felt 
somewhat  doubtful  as  to  the  amount  of  material  likely  to  present  itself  in  his  section 
of  North  Carolina  in  view  of  the  limited  extent  of  the  dusty  trades  in  that  portion  of 
the  country.  He,  however,  further  agreed  to  undertake  whatever  duties  might  be 
assigned  to  him  in  connection  with  the  more  highly  involved  technical  aspects  of  the 
inquiry,  particularly  as  to  pathological  phases,  and  perhaps  autopsy  records,  etc. 

Dr.  Baldwin  then  directed  attention  to  the  fact  that  a  limited  amount  of  animal 
experimentation  was  being  carried  on  at  his  laboratory,  limited  for  the  time  being 
to  exposure,  under  control,  of  guinea  pigs  to  finely  comminuted  granite  dust.  He 
hopes  later  to  carry  on  similar  experiments  with  marble  dust,  and  the  chairman  agreed 
to  obtain  for  him  a  sufficient  quantity  of  limestone  dust  for  the  same  purpose.  He 
explained  that  three  forms  of  experiments  were  carried  on — first,  with  animals  in 
thorough  health  and  not  heretofore  exposed  to  tuberculosis;  second,  with  animals 
suffering  from  slight  tuberculosis  infection;  and  third,  with  animals  infected  with 
tuberculosis  subsequent  to  prolonged  dust  exposure. 

The  order  of  procedure  in  the  proposed  investigation  was  then  agreed  upon  more  or 
less  as  follows: 

1.  The  preparation  of  a  brief  outline  of  the  general  subject,  limited  to  the  stone 
industries  of  the  State  of  Vermont,  by  the  chairman,  possibly  amplified  by  a  pre- 
liminary personal  investigation  of  the  conditions  in  the  territory,  with  conclusions 
useful  for  the  guidance  of  the  field  workers. 

2.  A  qualified  preliminary  technical  investigation  of  industrial  conditions  and 
industrial  processes  in  the  granite  and  marble  industries  of  the  State  of  Vermont  by 
the  chairman  and  one  of  his  office  assistants  through  the  cooperation  of  the  Prudential. 
This  study  would  include  a  descriptive  account  of  the  most  injurious  or  dust-producing 
industrial  processes,  with  illustrations  of  the  tools  used,  etc.    This  investigation 
would  probably  be  made  by  Mr.  Edwin  E.  A.  Fisher. 

3.  The  chairman  agreed  to  take  steps  to  ascertain,  through  the  cooperation  of  the 
State  Board  of  Health,  the  best  method  by  which  a  transcript  might  be  had  or  a 
reanalysis  might  be  made,  of  the  death  certificates  of  stoneworkers  in  certain  selected 
towns  of  the  State  of  Vermont.     If  it  should  be  found  impossible  for  the  State  Board 
of  Health  on  account  of  limited  office  force  to  assist  in  the  required  statistical  work, 
the  chairman  intimated  the  probability  that  the  Prudential  would  assume  the  expense 
of  such  an  investigation,  aside  from  the  company's  willingness  to  assume  the  expense 
of  printing  the  required  blanks  for  the  general  conduct  of  the  field  investigations  and 
the  physical  examinations  subsequent  thereto. 

4.  The  so-called  house-to-house  investigation  should,  as  far  as  practicable,  be  under 
the  direction  and  control  of  the  State  Board  of  Health  of  Vermont.     It  should  proceed 


MORTALITY  FROM  TUBERCULOSIS  IN  DUSTY  TRADES.  21 

in  conformity  to  the  best  examples  of  corresponding  investigations  in  this  country 
and  abroad,  and  the  data,  as  far  as  practicable,  should  be  made  comparable  with  other 
investigations  so  as  to  enhance  their  value  for  future  use. 

5.  The  more  involved  technical  investigation  of  the  industry  should  be  jointly 
under  the  direction  of  the  United  States  Public  Health  Service  and  the  United  States 
Bureau  of  Mines,  corresponding,  as  far  as  practicable,  to  the  investigations  made  by 
these  two  Government  departments  into  the  relation  of  siliceous  dust  to  pulmonary 
disease  among  miners  in  the  Joplin  district  in  Missouri.     It  was  agreed  that  the  chair- 
man should  frame  a  resolution  for  adoption  by  the  executive  committee  of  the  National 
Tuberculosis  Association  suggesting  the  official  cooperation  of  the  director  of  the 
United  States  Bureau  of  Mines  and  the  Surgeon  General  of  the  United  States  Public 
Health  Service,  corresponding  to  a  similar  resolution  transmitted  under  date  of  May, 
1911,  and  which  resulted  in  the  undertaking  of  the  investigation  previously  referred  to. 

6.  The  physical  examination  of  employees,  and  possibly  members  of  their  families, 
should,  if  any  way  practicable,  be  under  at  least  the  direction  of  the  United  States 
Public  Health  Service,  in  affiliation,  however,  with  such  other  official  and  voluntary 
agencies  as  might  be  secured  to  enlarge  the  field  of  inquiry  and  to  improve  the  quality 
of  the  results. 

7.  The  X-ray  examinations  should  be  made  locally  but  in  cooperation  with  the 
Trudeau  Foundation,  the  State  sanatorium,  and  the  local  hospitals  in  the  districts 
concerned. 

8.  Post-mortem  examinations  should  be  obtained  in  a  sufficiently  large  number, 
possibly  on  the  basis  of  a  ruling  of  the  State  Board  of  Health,  concerning  the  modifica- 
tion of  doubtful  death  certificates. 

9.  The  problem  of  domestic  infection,  or  more  precisely,  the  incidence  of  tubercu- 
losis among  the  wives  and  children  of  stoneworkers,  should  be  made  a  matter  of  separate 
inquiry,  so  as  to  avoid  confusion  with  the  main  purpose  of  the  investigation,  having 
primarily  and  practically  exclusively  to  do  with  the  health-injurious  consequences 
of  continuous  and  considerable  dust  inhalation  in  the  stone  industries  of  the  State. 
It  was  agreed,  however,  that,  as  far  as  practicable,  the  entire  family  should  be  included 
in  the  personal  examination. 

10.  The  problem  of  prevention  obviously  could  not  receive  consideration  until 
the  entire  new  material  had  been  properly  assembled  and  made  the  subject  matter 
of  qualified  discussions  and  of  definite  recommendations. 

11.  Finally,  the  proper  care  of  incipient  cases,  and  possibly  the  still  more  involved 
question  of  workmen's  compensation  for  fibroid  lung  diseases  contracted  in  the  course 
and  in  consequence  of  the  employment  were  left  open  for  future  consideration. 

Aside  from  the  foregoing,  it  was  agreed  that,  as  far  as  practicable,  the  slate  and  talc 
industries  of  Vermont  should  be  brought  within  the  plan  and  scope  of  the  investiga- 
tion, although  apparently  limited  to  the  health-injurious  consequences  of  granite 
and  marble  dusts. 

The  question  of  the  pottery  industry,  and  that  of  dust  exposure  in  flint  mills,  was 
left  for  consideration  at  a  subsequent  meeting,  but  the  chairman  agreed  to  make 
tentative  inquiries  into  the  subject. 

Dr.  Caverly  directed  special  attention  to  dust-producing  processes  in  the  slate 
industry  in  Rutland  County,  and  the  generation  of  vast  quantities  of  dust,  sufficient 
to  prove  at  least  obnoxious  to  the  surrounding  country,  and  resulting  in  lawsuits  on 
the  ground  of  damage  done  to  vegetation,  etc. 

The  committee  then  closed  the  discussion  concerning  the  granite  and  marble  indus- 
tries and  took  up  the  question  of  the  limestone  industries  of  Southern  Indiana,  which 
will  be  dealt  with  in  a  subsequent  report.  t 

Very  truly,  yours, 

FREDERICK  L.  HOFFMAN, 
Chairman  Committee  on  Mortality  from  Tuberculosis  in  Dusty  Trades. 


22  MORTALITY  FROM  TUBERCULOSIS  ITS   DUSTY  TRADES. 

In  a  second  communication  dated  July  25,  1918,  the  report  upon 
the  conference  to  the  president  of  the  association  was  completed. 

Dr.  DAVID  R.  LYMAN, 

President  National  Tuberculosis  Association,  Wallingford,  Conn. 

DEAR  DR.  LYMAN:  After  having  fully  agreed  upon  the  details  of  the  proposed  in- 
vestigation of  the  stone  industry  in  the  State  of  Vermont,  the  committee  took  up  the 
question  of  a  corresponding  though  possibly  less  extensive  investigation  into  the  dust 
problem  of  the  limestone  industries  of  southern  Indiana.  The  chairman  presented 
the  results  of  a  fairly  extended  correspondence  with  the  secretary  of  the  Bedford 
Stone  Club  Auxiliary  of  Bedford,  Ind.,  and  some  statistical  data  conveying  an 
urgent  suggestion  for  a  thorough  inquiry  into  local  Conditions,  briefly  set  forth  as 
follows: 

In  consequence  of  a  controversy  involving  the  usj  of  the  pneumatic  tools  in  stone- 
cutting,  etc.,  and  the  alleged  mechanical  injuries  to  the  hands  and  arms,  all  of  which 
has  been  made  the  subject  of  exhaustive  investigations  by  representatives  of  the 
industry,  the  labor  union,  the  Federal  Bureau  of  Labor  Statistics,  the  United  States 
Public  Health  Service,  etc.,  the  question  had  incidentally  been  raised  as  to  the  possi- 
ble injuriousness  of  pneumatic  tools  on  account  of  the  large  quantities  of  fine  dust 
raised  during  the  mechanical  operations.  The  viewpoint,  however,  had  been  ad- 
vanced by  the  secretary  of  the  Bedford  Stone  Club  Auxiliary  that  "Tuberculosis 
unquestionably  is  far  more  prevalent  in  the  granite  and  sandstone  industries  than  in 
the  Indiana  limestone  industry.  Not  only  are  our  accommodations  more  modern 
than  generally  found  elsewhere,  but  the  nature  of  the  stone  itself  is  such  as  to  preclude 
most  of  the  detrimental  elements  which  are  a  source  of  objection  in  other  sections 
of  the  business.  Indiana  limestone,  as  commonly  worked,  is  moist,  in  fact,  one  may 
say,  wet.  Furthermore,  its  physical  make-up  is  such  as  to  cause  an  almost  total  ab- 
sence of  sharp,  gritty  particles  which,  according  to  my  (Dr.  Richter's)  understanding, 
are  the  chief  objection  in  granite  and  sandstone." 

Dr.  Richter  referred  also  to  the  report  of  Dr.  Barnes,  of  St.  Louis,  and  subsequent 
investigations  by  Dr.  Leake,  of  the  Public  Health  Service,  and  Dr.  Edsall,  the  well- 
known  authority  on  occupational  diseases,  to  the  effect  that  "They  are  unanimous 
in  their  finding  that  the  prevalence  of  dust  in  the  mills  of  the  Indiana  limestone 
district  is  negligible  factor.  This  because  the  stone  as  worked  here  is  drenched  with 
water  at  various  stages  of  fabrication,  which  water  is  not  evaporated  to  any  extent 
until  the  stone  is  practically  ready  for  loading." 

"These  doctors  have  further  agreed  that  the  general  health  of  all  the  stonecutters 
examined  and  interviewed  here  is  exceptionally  good  and  that  without  question 
or  .doubt  they  rate  much  higher  in  that  regard  than  stonecutters  generally." 

Assuming  for  the  time  being  that  these  conclusions  are  correct,  it  would  neverthe- 
less be  of  the  first  importance  to  ascertain  with  the  required  degree  of  thoroughness 
and  scientific  accuracy  the  facts,  more  or  less  in  the  manner  as  has  been  done  so  ad- 
mirably by  the  United  States  Bureau  of  Mines  in  their  recent  report  on  Siliceous 
Dusts  in  Relation  to  Pulmonary  Diseases  among  Miners  in  the  Joplin  District,  Mis- 
souri. The  committee  therefore  agree  that  in  view  of  the  most  hearty  and  unqualified 
assurances  of  active  cooperation  on  the  part  of  the  Bedford  stone  industry  the  entire 
subject  matter  should  be  taken  up  with  reference  to  the  limestone  industry  of 
southern  Indiana.  It,  however,  was  clearly  recognized  that  the  strictly  technical 
phases  of  the  investigation  would  probably  have  to  be  taken  care  of  by  the  United 
States  Bureau  of  Mines  and  the  United  States  Public  Health  Service. 

As  a  matter  of  record  the  chairman  read  from  a  letter  addressed  to  him  by  the  secre- 
tary of  the  Bedford  Stone  Club  Auxiliary,  dated  January  19,  1918,  reading  in  part: 

"It  seems  to  us,  therefore,  that  the  matter  to  which  we  refer  hereinbefore  must  be 
of  vital  interest  to  you.  Our  interest  in  it  is  twofold.  We  want  to  show  in  all  fairness 


MORTALITY  FROM  TUBERCULOSIS  IN  DUSTY  TRADES.  23 

that  the  effects  of  the  pneumatic  tool  are  not  such  as  to  warrant  discrimination.  We 
want  further  to  create  for  our  workmen  a  condition  which  will  give  them  every  benefit 
ao  far  as  insurance,  among  other  things,  is  concerned,  which  may  rightly  accrue 
from  the  fact,  first,  that  the  pneumatic  tool  does  not  imply  hazard,  and,  second, 
that  in  our  operations  in  Indiana  tuberculosis  owing  to  dust  is  practically,  if  not 
entirely,  an  unknown  experience." 

It  having  been  agreed  that  such  an  investigation  should  be  undertaken,  it  was 
thought  best,  however,  to  postpone  the  work  in  Indiana  until  the  plan  of  inquiry 
had  been  thoroughly  worked  out  for  Vermont.  The  chairman  was  able  to  inform 
the  committee  that  assurances  had  come  to  him  from  the  State  health  officer  of  Indi- 
ana that  the  Board  of  Health  of  that  State  would  most  heartily  cooperate,  and  that 
in  addition  a  corresponding  offer  of  cooperation  had  also  been  forthcoming  from  the 
general  office  of  the  Journeymen  Stonecutters'  Association,  Mr.  Walter  W.  Drayer, 
general  secretary,  Indianapolis.  Mr.  Drayer's  letter  concludes  with  the  statement 
which  is  here  incorporated  as  a  matter  of  record,  that  he  is  "only  too  pleased  to  assist 
you  in  any  way  possible  in  your  investigation  of  health  conditions  in  the  stone  trade 
of  Indiana." 

Dr.  Alice  Hamilton  reported  briefly  upon  her  own  investigations  in  Indiana,  almost 
exclusively,  however,  with  reference  to  the  alleged  injurious  mechanical  effects  of 
pneumatic  tools,  with  which,  of  course,  the  committee  on  dusty  trades  has  no  direct 
concern.  She  gave  the  assurance  of  her  entire  willingness  to  cooperate  to  the  fullest 
extent  and  it  is  to  be  hoped  that  this  may  be  feasible  through  the  United  States  Bureau 
of  Labor  Statistics.  Dr.  Hamilton's  experience,  it  was  clearly  recognized,  would  be 
invaluable  to  the  committee,  more  so  in  view  of  the  fact  that  she  had  also  made  personal 
investigations  in  connection  with  these  matters  in  Vermont. 

Before  concluding  its  session  the  committee  considered,  briefly,  the  problem  of 
metallic  dust,  as  observed  in  connection  with  the  military  industries  of  the  Govern- 
ment. Dr.  Lanza  intimated  that  some  useful  information  would  probably  be  forth- 
coming in  consequence  of  his  investigations  of  conditions  at  the  plants  of  the  Winchester 
Arms  Co. 

Dr.  Baldwin  explained  briefly  his  laboratory  experiments  with  guinea  pigs  exposed 
intermittently  to  the  inhalation  of  granite  dust,  which,  however,  had  not  proceeded 
sufficiently  far  to  justify  definite  conclusions.  The  committee  were  shown  over  the 
laboratory  and  gained  much  useful  knowledge.  Dr.  Baldwin  incidentally  brought  up 
the  question  of  the  health  injuriousuess  of  the  dust  inhaled  by  the  workmen  employed 
in  the  carborundum  plants  at  Niagara  Falls.  When  he  had  first  visited  this  plant  some 
years  ago,  he  had  been  assured  of  the  practically  noninjuriousness  of  the  dust,  regard- 
less of  the  obvious  and  perceptible  evidence  to  the  contrary.  Subsequently  a  number 
of  the  employees  from  this  plant  had  come  to  Saranac  Lake  suffering  from  tuberculosis, 
and,  although  the  evidence,  of  course,  was  not  final  as  to  whether  the  disease  had  been 
contracted  in  consequence  of  the  exposure  to  carborundum,  a  general  conclusion  to 
this  effect  seems  justified  in  view  of  the  conditions  observed.  It  was  therefore  agreed 
that  if  the  executive  committee  of  the  National  Tuberculosis  Committee  should  meet 
as  intended  at  Buffalo,  in  August,  the  committee  on  dusty  trades  would  meet  jointly 
and  perhaps  take  up  a  brief  investigation  into  the  conditions  at  Niagara  Falls  in  the 
plants  referred  to.  Dr.  Baldwin  assured  the  committee  that  Dr.  Bowman,  in  charge 
of  the  welfare  work  and  himself  a  sufferer  from  tuberculosis  in  the  incipient  stage  of  the 
disease,  would  no  doubt  cooperate  in  the  fullest  extent. 

The  committee  thereupon  adjourned  subject  to  the  call  of  the  chairman. 
Very  truly,  yours, 

FREDERICK  L.  HOFFMAN, 
Chairman  Committee  on  Mortality  from  Tuberculosis  in  Dusty  Trades, 

National  Tuberculosis  Association. 


24  MORTALITY  FROM  TUBERCULOSIS  IN  DUSTY  TRADES. 

On  the  occasion  of  the  meeting  of  the  executive  committee  preced- 
ing the  meeting  of  the  special  committee  a  resolution  had  been  intro- 
duced by  the  chairman  of  the  committee,  and  had  been  unanimously 
approved,  as  follows: 

RESOLUTION  UNANIMOUSLY  ADOPTED  AT  THE   MEETING  OF  THE   EXECUTIVE  COMMITTEE 
OF  THE    NATIONAL   TUBERCULOSIS   ASSOCIATION. 

Whereas  the  special  committee  on  the  scientific  study  of  the  dusty  trades  in  their 
relation  to  the  relative  frequency  of  tuberculous  diseases  have  unanimously  agreed  to 
concentrate  their  efforts  for  the  time  being  upon  the  morbidity  and  mortality  of  men 
employed  in  the  stone  industry  of  the  State  of  Vermont  and  the  limestone  industry 
of  the  State  of  Indiana;  and 

Whereas,  in  the  furtherance  of  their  work,  the  committee  are  most  urgently  in  need 
of  governmental  cooperation  in  certain  highly  specialized  matters  of  field  inquiries  and 
laboratory  research;  be  it  therefore 

Resolved,  That  the  United  States  Public  Health  Service  and  the  United  States 
Bureau  of  Mines  be  requested  to  undertake  jointly  a  thorough  investigation  of  the  dust 
problem  in  the  stone  industry  of  Vermont  and  Indiana,  with  a  view  to  the  ascertain- 
ment of  all  the  facts  having  a  bearing  upon  the  excessive  incidence  of  tuberculous  and 
nontuberculous  respiratory  diseases  in  the  several  branches  of  the  industries  referred 
to,  and  the  determination  of  the  best  possible  methods  and  means  whereby  the  mor- 
bidity and  mortality  of  the  men  employed  therein  may  be  materially  reduced  by  the 
adoption  of  more  effective  safeguards  and  improved  methods  of  sanitation  than  those 
in  use  at  the  present  time. 

Assured  of  the  hearty  cooperation  of  the  Vermont  State  Board  of 
Health,  the  efforts  of  the  chairman  were  concentrated  upon  the 
Vermont  stone  industry  as  the  most  promising  line  of  research  during 
the  summer  and  early  fall.  Of  interest  and  value  is  therefore  a  letter 
from  the  secretary  of  the  board,  Dr.  Charles  F.  Dalton,  dated  July  22, 
1918,  reading  as  follows: 

Under  separate  cover,  I  am  sending  you  a  rough  model  of  a  granite  cutter's  hand 
tool  for  combining  pneumatic  suction  with  compressed  air.  The  principle  of  this  tool 
is  that  a  circular  jacket  is  placed  around  the  shaft  of  the  tool  which  is  either  square 
or  several  sided,  leaving  a  space  through  which  the  granite  dust  can  be  withdrawn. 
The  working  of  this  tool  would  require  a  hose  for  suction  as  well  as  the  pressure  hose 
and,  as  this  would  materially  add  to  the  weight,  it  has  been  objected  to  on  this  ground 
by  some  granite  workers  who  have  seen  it.  However,  I  am  informed  that  this  tool 
which  I  am  sending  you  has  actually  been  used  and  demonstrated  that  it  will  do  the 
work  if  some  difficulties  can  be  overcome.  This  model  was  made  by  Mr.  Allan 
Calhoun,  formerly  factory  inspector  for  the  State  of  Vermont,  but  he  has  turned  it 
over  to  the  State  Board  of  Health  for  such  use  as  can  be  made  of  it. 

I  have  personally  gone  over  the  matter  of  the  use  of  a  hand  tool  with  representatives 
of  the  granite  manufacturers  in  Barre  and  also  with  the  granite  cutters.  They  are 
apparently  ready  and  willing  to  adopt  any  feasible  plan  for  the  elimination  of  granite 
dust  from  hand  tools,  but  at  my  last  conference  with  them  they  did  not  know  of  any 
practical  method  of  accomplishing  this  result. 

All  this  is  at  the  suggestion  of  Dr.  Caverly,  who  tells  me  that  you  are  likely  to  come 
to  Vermont  some  time  in  the  near  future  to  visit  the  Barre  granite  industries.  I 
shall  be  glad  to  accompany  you  on  the  trip  and  am  much  gratified  that  this  work  is 
being  taken  up. 


MORTALITY  FROM  TUBERCULOSIS  IN  DUSTY  TRADES.  25 

This  letter  was  amplified  by  a  subsequent  communication  dated 
July  27,  1918,  which  is  also  given  in  its  entirety: 

Your  letter  addressed  to  nie  in  Montpelier  has  just  reached  me  via  Burlington. 
You  speak  in  your  letter  of  the  desirability  of  our  board  assisting  at  least  in  the  house- 
to-house  inquiry  that'  will  be  made  into  the  stonecutting  industries  of  Vermont, 
as  a  result  of  our  conference  at  Saranac  Lake.  I  know  that  our  board  will  be  in  entire 
sympathy  with  this  work.  However,  at  the  present  time,  by  reason  of  resignations, 
due  to  war  work  and  other  things,  we  are  crippled.  We  have  no  inspector  just  now, 
but  I  have  no  doubt  the  executive  secretary  of  the  State  Tuberculosis  Association, 
who  works  under  the  auspices  of  our  board  part  of  the  time,  may  be  utilized  for  some 
inquiries  in  this  work.  We  shall  have,  I  hope,  an  inspector  soon.  If  you  can  defer 
the  investigation  for  a  month  or  two  I  think  we  should  be  able  to  give  you  more  assist- 
ance. The  matter  will  be  brought  to  the  attention  of  the  board  at  its  next  monthly 
meeting,  which  occurs  August  8,  and  you  will  be  notified  more  .specifically  of  the 
extent  of  cooperation  which  may  be  expected  from  us.  You  are  perfectly  right  in 
thinking  that  the  board  will  furnish  you  every  assistance  possible  in  this  work,  in 
which  we  are  all  very  much  interested,  the  importance  of  which  has  been  recognized 
by  us  for  a  great  while. 

There  is  included  also  a  statement  presented  by  Dr.  Caverly 
at  the  Saranao  Lake  meeting  of  the  committee,  which  will  be  found 
useful  for  future  reference : 

Number  of  granite  cutters  in  the  Barre  district  (comprising  about  6  towns),  3,000. 

Number  of  helpers,  1,000. 

Number  of  men  in  quarries,  1,000. 

Barre  City,  with  a  population  in  1910  of  10,784,  had  135  deaths  from  all  causes; 
28,  or  20.7  per  cent,  were  from  tuberculosis  of  the  lungs;  33,  or  24.4  per  cent  of  these 
deaths  were  from  tuberculosis  in  some  form. 

Number  of  deaths  from  tuberculosis  of  the  lungs  in  the  State  runs  in  recent  years 
from  250  to  300,  hence  the  number  of  deaths  in  the  city  of  Barre  is  approximately  10 
per  cent  of  all  that  occurred  in  the  State. 

Number  of  admissions  at  the  State  sanatorium  for  incipient  tuberculosis  since  it 
was  opened,  10J  years  ago.  of  granite  cutters,  quarrymen,  and  granite  workers  has 
been  56  out  of  a  total  number  of  admissions  of  963,  or  5.8  per  cent. 

Barre  Town,  which  is  a  township  surrounding  the  city,  with  a  population  of  419, 
had  4  deaths  from  tuberculosis  in  1917,  out  of  a  total  number  of  deaths  of  51. 

Montpelier  City,  with  a  population  of  7,856,  had  13  deaths  from  tuberculosis  of  the 
lungs  in  1917,  with  total  deaths  of  121 .  Pulmonary  tuberculosis  rate  is  10.7  of  the  total 
deaths. 

Number  of  admissions  to  the  sanatorium  among  marble  tracers,  graders,  polishers, 
cutters,  and  workers  since  institution  opened,  10.  Number  of  slate  quarrymen 
and  cutters,  7. 

The  marble  and  slate  industries  are  centered  in  Rutland  County. 

The  secretary  of  the  Granite  Manufacturer's  Association  is  Mr.  Hinmaii,  of  Barre 
City.  Dr.  Alice  Hamilton,  of  Chicago,  has  recently  made  an  investigation  of  the 
granite  indutry  for  the  Department  of  Labor  at  Washington. 

As  bearing  upon  the  more  general  work  of  the  committee,  there 
is  included  here  a  letter  from  the  director  and  chief  engineer  of  the 
division  of  sanitary  engineering  of  the  State  Department  of  Health 
of  West  Virginia,  Mr.  Mayo  Tolman,  dated  August  2,  1918: 


26  MORTALITY  FROM  TUBERCULOSIS  IN  DUSTY  TRADES. 

FREDERICK  L.  HOFFMAN, 

Third  Vice  President  and  Statistician,  Prudential  Insurance  Co., 

Newark,  N.  J. 

DEAR  SIR:  I  was  deeply  appreciative  to  receive  your  kind  letter  of  recent  date  in 
reference  to  my  "Sanitary  survey  of  Charleston."  This  was  particularly  the  case  as 
not  only  has  the  report  not  received  any  comment  in  this  city  but  has  failed  to  awaken 
the  slightest  interest,  so  deeply  set  has  Charleston  become  in  the  rut  she  has  traveled 
for  years. 

I  am  sorry  that  I  can  not  report  more  definitely  upon  the  tuberculosis  condition  at 
the  Kelly  Ax  Works.  The  works  have  been  investigated  on  six  different  occasions 
by  the  State  Department  of  Health,  on  several  other  occasions  by  Miss  Erma  Slack,  the 
nurse  of  the  Anti-Tuberculosis  League,  and  all  investigators  report  that  the  deaths 
among  ax  grinders  have  accurred  among  those  men  who  are  known  to  have  been 
infected  before  the  installation  of  dust  removal  machines.  However,  Dr.  Holt  Barks- 
dale,  one  of  the  leading  younger  physicians  in  Charleston  and  a  man  who  has  made 
a  special  study  of  tuberculosis  in  Charleston,  is  of  the  opinion  that  the  ax  plant  is  still 
responsible  for  much  tuberculosis  in  Charleston.  Living  conditions  in  the  vicinity 
of  the  ax  works  are  as  noted  in  the  report,  deplorable,  and  there  are  well  authenti- 
cated cases  where  men  who  appeared  perfectly  well  have  used  the  same  bed  with 
advanced  cases  of  tuberculosis  and  it  would  seem  possible  that  the  disease  has  been 
spread  in  this  fashion.  My  own  experience  with  the  ax  plant  shows  that  the  dust 
removers  are  not  given  sufficient  attention  to  make  them  fully  effective  at  all  times. 
I  think  the  illustration  in  the  report  will  prove  this  for  sparks  can  be  seen  flying  well 
towards  the  ceiling. 

Again  thanking  you  for  your  kindness  in  commenting  on  this  report,  I  remain, 
Most  sincerely,  yours, 

MAYO  TOLMAN, 
Chief  Engineer,  State  Department  of  Health. 

There  is  also  included  a  letter  from  Dr.  H.  R.  M.  Landis,  of  the 
Henry  Phipps  Institute,  bearing  more  directly  upon  the  question 
of  proper  blanks  and  forms  to  be  used  in  connection  with  the  pro- 
posed investigation  .in  the  State  of  Vermont. 

I  quite  agree  with  you  that  many  of  the  blanks  used  in  these  investigations  are 
too  much  overloaded  with  detail.  I  have  Lanza's  report  and  I  think  you  might  as 
well  follow  that.  I  do  feel,  however,  that  much  more  extensive  study  of  the  outside 
life  of  the  men  is  needed  than  is  contained  in  this  industrial  investigation  with  the 
one  exception  of  the  study  made  by  Mrs.  Lit  and  myself.  For  example,  I  saw  a 
potter  yesterday  who  acquired  a  slight  tubercular  infection  in  addition  to  his  dust 
disease  and  made  a  perfect  recovery  and  returned  to  his  trade  as  a  potter.  He  re- 
mained perfectly  well  for  a  year  and  a  half  and  then  broke  down  as  a  result  of  starting 
drinking.  I  cite  this  simply  to  draw  attention  to  the  fact  that  it  is  necessary  to  know 
how  and  where  these  men  live  before  I  am  convinced  that  their  method  of  living  has 
as  much  influence,  if  not  more  influence,  as  has  the  evils  of  their  employment.  I  feel 
that  any  investigation  such  as  you  are  about  to  make  should  result  in  a  very  incom- 
plete study  if  it  fails  to  cover  this  phase  of  the  subject.  It  should  not  be  very  diffi- 
cult to  get  a  good  family  history,  seeing  the  presence  or  absence  of  tuberculosis  in 
the  family,  the  general  hygienic  condition  of  the  home  and  the  neighborhood,  and  the 
present  habits  as  to  food,  hours  of  sleep,  and  indulgence  in  alcohol. 

On  account  of  prolonged  absence  from  office  in  connection  with 
an  extended  western  trip,  the  chairman  found  it  impossible  to  under- 
take the  proposed  investigation  in  Vermont,  but  assigned  the  sub- 


MORTALITY  FROM  TUBERCULOSIS  IN  DUSTY  TRADES.  27 

ject  to  one  of  his  office  assistants,  Mr.  Sylvester  Schattschneider, 
with  extended  experience  in  field  investigations  of  this  kind. 

The  outbreak  of  the  influenza  epidemic  occurred  at  just  about 
the  time  when  the  field  investigation  was  to  have  been  commenced, 
and  the  same  had  therefore  to  be  abandoned  for  the  time  being. 

Still  more  lamentable  was  the  untimely  death  of  Dr.  Caverly, 
president  of  the  State  Board  of  Health  of  Vermont,  to  whose  active 
cooperation,  high  scientific  attainments,  and  always  hopeful  attitude 
of  mind,  the  chairman  and  the  committee  are  under  lasting  obligation. 

Partly,  as  stated,  on  account  of  prolonged  absence  from  office, 
but  also  on  account  of  the  influenza  epidemic,  etc.,  no  subsequent 
meetings  of  the  committee  were  held.  It  is  hoped,  however,  that  a 
meeting  can  be  arranged  for  in  the  near  future;  but  frequent  con- 
ferences have  been  had  on  the  part  of  the  chairman  with  members 
of  the  committee  concerning  matters  of  detail. 

o 


NON-RENEWABLE 


DUE  2  WKS  FROM  DATE  RECEIVED 


Univei 

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Li 


